M. Puche

Hospital Clínico Universitario de Valencia, Valenza, Valencia, Spain

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Publications (5)1.94 Total impact

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    ABSTRACT: Coronoid hyperplasia (CH) is an abnormal bony elongation of a histologically normal coronoid process. Its definitive cause remains unknown. To analyze the possible implication of congenital hypotonia in the pathogenesis of early coronoid overgrowth. Two infants with congenital hypotonia were evaluated for limited mouth aperture. Bilateral CH was diagnosed. Transoral coronoidectomy was followed by an early dynamic physiotherapy program. Significant improvement of maximum interincisal opening was achieved. The review of the scientific literature proved the diagnosis of CH in the infant age group is extremely unusual and the etiology of the condition is still uncertain. Besides mouth opening restriction, clinical features of coronoid hyperplasia in infants can include suction or deglutition anomalies, failure to thrive and recurrent episodes of choking or aspiration pneumonia. The authors hypothesize reduced fetal mandibular movements and deglutition as a result of congenital hypotonia may lead to relative hyperactivity of the temporalis muscle that is not counterbalanced by the infra and suprahyoid muscles, thereby facilitating coronoid overgrowth.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 08/2011; 40(6):e155-8. · 1.25 Impact Factor
  • International Journal of Oral and Maxillofacial Surgery - INT J ORAL MAXILLOFAC SURG. 01/2011; 40(10).
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    ABSTRACT: It is considered that up to 20% of the craniosinostosis patients require secondary surgeries. Different techniques have been used in craneofacial surgery for the reconstruction of great osseous defects in pediatric patients for many years. This paper is about a new technique to obtain osseous graft for covering osseous cranial defects, using particulate bone, harvested from the patient calvarian using a hand-driven brace and covered with a fibrin adhesive. This is a very simple technique, which provides a great amount of bone from the patient himself, therefore producing a small morbidity. Since 2007 the authors have been using autologous particulate bone harvested from de patient calvarian for the reconstruction of different size osseous defects found in craneofacial surgery, especially in pediatrics patients. Although alloplastic materials and bone substitutes have been used for cranial reconstruction, the best option is the autogenous bone. In contrast to synthetic materials autologous grafts have a faster osteointegration, due to their osteogenic, osteoinductive and osteconductive properties. Harvesting the bone from the calvarian patient produces a minimal morbidity compared to the extraction of grafts from other donor sites such as rips or hip. The use of autologous particulate bone in craniosinostosis surgery reduces the risk of second interventions due to secondary ossifications defects. On the other hand, the harvest is easy and the supply of bone it is enough in pediatric patients.
    Neurocirugia (Asturias, Spain) 04/2010; 21(2):118-24. · 0.34 Impact Factor
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    ABSTRACT: Se considera que hasta un 20% de intervenidos de craneosinostosis requieren cirugías secundarias. Son varias las técnicas que se han venido utilizando dentro de la cirugía craneofacial para la reconstrucción de grandes defectos óseos en pacientes pediátricos a lo largo de los años. Presentamos una nueva técnica de obtención de injerto de hueso para el recubrimiento de defectos óseos craneales, en la que se utiliza hueso particulado, obtenido de la calota del paciente mediante un berbiquí y unificado con un adhesivo de fibrina. Está técnica es sencilla y provoca poca morbilidad en el paciente. Además, permite obtener una importante cantidad de hueso. Desde el año 2007 utilizamos el hueso particulado autólogo obtenido de la calota del paciente para la corrección de defectos óseos grandes o pequeños que se nos presentaban en la cirugía craneofacial practicada sobre todo en pacientes pediátricos. Aunque los materiales aloplásticos y sustitutos de hueso han sido utilizados para la reconstrucción de cráneos, el hueso autógeno es la mejor opción. A diferencia de los materiales sintéticos, los injertos autógenos tienen una más rápida osteointegración ya que son osteogénicos, osteoinductivos y osteoconductivos, siendo además el injerto de la misma naturaleza que el hueso donante. La morbilidad producida al paciente por la obtención del hueso de la calota con esta técnica es mínima, en comparación con otras zonas donantes como costilla o cadera. La utilización del hueso particulado autólogo durante la cirugía de las craneosinostosis reduce la necesidad de segundas intervenciones por defectos de osificación secundarios. Por otro lado, su obtención es fácil y la cantidad de hueso extraído es suficiente para los pacientes pediátricos.
    Neurocirugia (Asturias, Spain) 01/2010; · 0.34 Impact Factor
  • Journal of Cranio-maxillofacial Surgery - J CRANIO MAXILLOFAC SURG. 01/2008; 36.