Skeletal Changes After Alt-RAMEC Protocol in Cleft Lip and Palate: A Systematic Review and Meta-Analysis

Objective To evaluate skeletal outcomes of the Alt-RAMEC protocol with facemask therapy compared with conventional rapid maxillary expansion (RME) in patients with cleft lip and/or palate. Design Systematic review and meta-analysis. Setting Data from international databases (PubMed, Embase, Scopus, Web of Science, CENTRAL, clinical trials registers, and Google Scholar) were analyzed. Patients/Participants Four studies involving approximately 136 patients with cleft lip and/or palate met inclusion criteria. Interventions Alternate RME and Constriction (Alt-RAMEC) followed by facemask protraction versus conventional expansion protocols. Main Outcome Measure(s) Cephalometric skeletal parameters (SNA, SNB, and ANB) and maxillary advancement. Results Alt-RAMEC with facemask produced a greater increase in SNA compared with controls (SMD 1.04; 95% CI 0.60-1.49; I ² = 0%), while SNB changes were non-significant. ANB changes were variable across studies ( I ² = 96%). Certainty of evidence was moderate for SNA and low for SNB. Conclusions Alt-RAMEC combined with facemask therapy may yield greater anterior maxillary displacement in cleft lip and palate patients than conventional RME protocols, though evidence remains limited. Standardized multicenter studies with long-term follow-up are needed.