Witold Szyfter

Uniwersytet Medyczny im.Karola Marcinkowskiego w Poznaniu, Posen, Greater Poland Voivodeship, Poland

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Publications (359)139.96 Total impact

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    ABSTRACT: The main aim of this article is the epidemiological analysis of patients treated due to oral and oropharyngeal cancer, with a special interest in the group under the age of 40, evaluation of the differences in the clinical course of the disease as well as assessment of the treatment results, regarding the age of the affected individuals. 523 individuals affected by oral and oropharyngeal cancer who were treated in the Otolaryngology and Laryngeal Oncology Department between 2000 and 2008. Precise analysis was performed on 360 out of 523 affected individuals, in whom full clinical status was determined; 13 patients were young adults. The retrospective analysis was created based on case histories, surgical protocols and emergency records. In young adults there is a markedly increased risk of organ involvement according to the Mann-Whitney U-test analysis (p = 0.044907). The probability of recurrence in the group of young adults is also much higher. Analysis of Kaplan-Meier test results indicated that the chance for the lack of recurrence within a 6-month period was 85.7%; however, the risk of recurrence increased, and after 12 months was equal to the arithmetic data (50%). Among young adults there is an increased risk of local recurrence following 12 months after surgical intervention. According to our observations, despite rapid progression and early recurrence in young adults (4/7) the prognosis for both groups is not statistically different.
    Contemporary Oncology / Wspólczesna Onkologia 01/2013; 17(3):286-90. · 0.21 Impact Factor
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    ABSTRACT: This paper presents the use of Omega 7 haptic console to control of KUKA LWR 4+ robot with integrated handle of puncture needles. KUKA manipulator was used to remove otogenic brain abscess. In the first part of the paper presents a simple simulator in which Omega 7 haptic console was used to carry out injection into a virtual brain abscess and the withdrawal of fluid from inside. In the following paper presents a experimental set-up with the KUKA robot and haptic console and the first test of the operation using the model of skull
    Medical Robotics Report. 01/2013; 2:26-34.
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    ABSTRACT: The face and neck are morphologically complex of anatomical structure. It determines the formation of a special susceptibility to various malformations. The aim of this study was to present anomalies of the first branchial cleft in unusual clinical course. Described three patients hospitalized in the Department of Otolaryngology in Poznan in the period from 2011 to 2012. In two patients the neck changes suggested the presence of a tumor and needed surgery twice. In one patient surgery was associated with a high risk of damage to the facial nerve. Discussed the pathogenesis, diagnosis and contemporary approach to the treatment of anomalies the first branchial cleft.
    Polski Przegląd Otorynolaryngologiczny. 01/2013; 2(1):26–29.
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    ABSTRACT: Primary lymphomas of the salivary glands are rare. It is estimated that they constitute no more than 5% of all lymphomas in different locations. The most common subtype developing in parotid glands is marginal zone B-cell mucosa associated lymphoid tissue type lymphoma (MALT) that belongs to a group of low-grade tumours. There are many factors associated with the incidence of that proliferative process: environmental and infectious agents as well as immune deficiency states. We describe a case of primary non-Hodgkin's lymphoma of the parotid gland arising in the background of previously undiagnosed and untreated Sjögren's syndrome in a 52-year-old woman. The article concerns a short review of the literature regarding etiology, symptoms, treatment and survival prognosis in that rare disease as well. MALT lymphomas should always be considered in the differential diagnosis of the tumors and swelling of the parotid gland area. A special, regular monitoring should include all patients with Sjögren's syndrome as those with the proven greater risk of developing that proliferative disease. The role of the laryngologist in the case of MALT-type lymphoma of the parotid gland should focus on a diagnosis and possible tumor cytoreduction with maximal saving of the facial nerve. The essential treatment of this pathology is one of the oncologists and haematologists.
    Otolaryngologia polska. The Polish otolaryngology 01/2013; 67(1):61-65.
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    ABSTRACT: Background and purpose: The object of the study was to present our own experience in the management of cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery. Material and methods: The study group consists of 5 patients treated in Department of Otolaryngology Poznan University of Medical Sciences in 2009-2011. Different materials and techniques were used to repair the perforations: infrahyoid flap, primary sutures supported by sternocleidomastoid muscle flap, thigh flap and forearm flap in two cases. Results: Four out of 5 patients were referred to our department in a poor general condition, with infected neck fistulas, three patients after prolonged conservative treatment, and three patients after initial attempts to repair the perforation outside our institution. One-stage reconstructive surgery was successful in three cases, while in two others secondary interventions were necessary. Total hospital stay ranged in the analysed group from 23 to 191 days, hospital stay in our department from 1 to 62 days, hospital stay from the final procedure from 18 to 26 days. Swallowing function was within normal limits in all cases 12-14 days after the surgery. Conclusions: The authors' experience shows that in long-lasting and infected cervical oesophageal and hypopharyngeal perforations following anterior cervical spine surgery distant flaps should be primarily used as a source of a well-vascularized and unchanged tissue. It seems to be crucial to repair the perforations immediately after the first symptoms appear - such an approach significantly reduces total hospital stay and improves the prognosis.
    Neurologia i neurochirurgia polska 01/2013; 47(1):43-48. · 0.49 Impact Factor
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    ABSTRACT: We report a case of a 20-year-old man who presented with discreet dysphagia for several months. Indirect laryngoscopy showed a swollen, reddened, thickened epiglottis and smooth, thickened, injected mucosa of aryepiglottic folds and postcricoid region. Thorough work-up was undertaken to exclude specific and non-specific infectious diseases, neoplasm, vascular disorders, immunodeficiency syndrome. Histology revealed actinomycotic colonies in biopsy specimen taken from the epiglottis. The inflammation was resolving gradually during long-term antibiotic-therapy. Actinomycosis should be considered in the differential diagnosis in unclear long-lasting inflammation of the supraglottis. The course of untreated actinomycosis can be fatal which is connected with progressive dissemination of the process and secondary abscesses formation in the lungs, liver and brain.
    Otolaryngologia Polska. 01/2013; 67(6):308–311.
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    ABSTRACT: The aim of this study is the evaluation of results of using new Baha abutment covered by hydroxyapatite (Baha® BA400, Cochlear Ltd.) which enables new surgical technique without soft tissue reduction. Material and methods The results of treatment of 9 adult patients were compared with results of 126 patients implanted earlier by standard technique with soft tissue reduction. Results In analyzed group we find: slight shortening of time of surgery, similar results of implant stability (RFA) before sound processor connection, very good cosmetic results in 6 patients, some soft tissue overhanging in 2 and retraction pocket formation and inflammation (Holgers 2) in 1, no numbness and pain in operated area in all operated. Conclusions New Baha abutment covered by hydroxyapatite (Baha® BA400) enables to safely use new surgical technique without soft tissue reduction. In authors’ opinion the most important benefit from this technique is limited bleeding during operation, reduction of using of coagulation and less risk of lesion of nerves and numbness or pain after operation. This technique required less time, but the need of measuring of soft tissue and choosing of proper abutment cause longer preoperative time, so the time of all procedure is only slightly shorter. The esthetic results and healing process confirm the advantage of technique without soft tissue reduction over standard technique. However in patients with a thick soft tissue there is a risk of soft tissue overhanging, so in such cases it is better to make a partial soft tissue reduction.
    Otolaryngologia Polska. 01/2013; 67(6):278–282.
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    ABSTRACT: The role of human papilloma viruses (HPV) in malignant and nonmalignant ENT diseases and the corresponding epidemiological burden has been widely described. International head and neck oncology community discussed growing evidence that oral HPV infection contributes to the risk of oro-pharyngeal carcinoma (OPC) and recommended HPV testing as a part of the work up for patients with OPC. Polish Society of ENT Head Neck Surgery and National Chamber of Laboratory Diagnosticians have worked together to define the minimum requirements for assigning a diagnosis of HPV-related conditions and testing strategy that include HPV specific tests in our country. This paper briefly frames the literature information concerning low risk (LR) and high risk (HR) HPV, reviews the epidemiology, general guidance on the most appropriate biomarkers for clinical assessment of HPV. The definition of HPV-related cancer was presented. The article is aiming to highlight some of major issues for the clinician dealing with patients with HPV-related morbidities and to introduce the diagnostic algorithm in Poland.
    Otolaryngologia polska. The Polish otolaryngology 01/2013; 67(3):113-134.
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    ABSTRACT: The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A-classic indications and group B-extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss.
    Archives of Oto-Rhino-Laryngology 12/2012; · 1.29 Impact Factor
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    ABSTRACT: OBJECTIVE: The aim of the study was to compare 2 laser systems, Er-Yag and CO2, in stapes surgery. STUDY DESIGN: The study design was retrospective. SETTING: The study was conducted at an academic tertiary referral center. PATIENTS: There were 88 women and 34 man in the analyzed group. The study was carried out on 142 ears: 52 on the right ear, 50 on the left ear, and 20 bilateral. Forty-seven ears underwent a CO2 laser-assisted stapedotomy, and 95 underwent Er-Yag-assisted stapedotomy; 23 left and 24 right ears were operated on using the CO2 laser. The Er-Yag laser was used in 48 right and 47 left ears. The follow-up time was at least 1 year. RESULTS: When the postoperative air-bone gap was compared with the preoperative air-bone gap for the 2 laser systems using the Student t test, as well as the Mann-Whitney U test, no statistical differences were found between the 2 groups, that is, with the use of Er-Yag and CO2 lasers. Also, no statistically significant differences were measured over all frequencies by the Student t test between preoperative and postoperative bone conduction in each group. CONCLUSION: To sum up, our observations have proven the usefulness of 2 laser systems: CO2 and Er-Yag lasers in stapes surgery. In both groups, a decrease in the hearing threshold was obtained.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 11/2012; · 1.44 Impact Factor
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    ABSTRACT: The aim of the study was to assess the correlation between non-malignant parotid gland tumors recurrence and patient related parameters (age, gender, duration of complaints), type of tumor (histological pattern, the tumor diameter, primary localization in superficial or a deep lobe) and the treatment methods. The endpoint of the analysis was to come up with the presentation of the treatment methods applied to pleomorphic adenoma. MATERIAL AND METHODS: between 1997 and 2006, 675 patients with non-malignant tumors of parotid gland were treated in a single institution, the tertiary center for ENT at the University Department in Poznań. In the case of 249 patients - extracapsullar dissection was the adopted method of treatment, while in the case of the remaining 426 patients - lateral parotidectomy was performed. RESULTS: recurrence of tumor was diagnosed in 24 cases: 16 patients were found to have tumor with pleomorphic adenoma, 5 - with cystadenolymphoma, 1 - with onkocytoma, 1 - with lipoma and 2 - with monomorphic adenoma. Recurrence most often occurred inter-related with the two most common types of tumors: pleomorhic adenoma in 5% of the cases (12 out of 237) and cystadenolymphoma in 2.9% of the cases (12 out of 414). This inter-relation is, however, of negligible statistical significance (p=0.175). Yet, the multifactor analysis confirmed, that in case of pleomorhic adenoma, the duration of complaints for more than 3 years (p=0.001) and any previous extracapsullar dissection procedure (p=0.016) applied at the removal of the tumor did exert statistically significant impact upon recurrence. Tumor removal via extracapsullar dissection turned out to pose almost a 4 time greater risk of recurrence as compared to the lateral parotidectomy method.
    Otolaryngologia polska. The Polish otolaryngology 11/2012; 66(6):392-396.
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    ABSTRACT: AIM: Presentation of experiences and results of surgical treatment of nasopharyngeal carcinoma. MATERIAL AND METHODS: 4 patients with nasopharyngeal carcinoma operated in Department of Otolaryngology and Laryngological Oncology of Poznan University of Medical Sciences between 2006 and 2011. In one case operation was performed via transpalatal approach and in other three cases via transfacial approach (via lateral rhinotomy). In all cases operation was supported by endoscopy and in advanced tumors (T4) also by navigation. RESULTS: We have not observed any important intraoperation and postoperation complications. Two patients with T2 tumor are disease free (observation time 5 years and 1 year). One patient with T4 tumor developed local recurrence and after few months died. Second patient with T4 tumor refused further control. CONCLUSIONS: 1. Instead of that nasopharyngeal carcinoma is typically treated by radiotherapy or in advanced stages by radio-chemotherapy, in some cases surgical treatment should be used. 2. The main indication to surgical treatment are residual and recurrent tumors after radiotherapy or radio-chemotherapy - both in nasopharynx and in cervical lymph nodes. It can be also used in primary, limited, radio-resistant tumors. 3. Appropriate surgical approach and using of endoscopy and navigations are important factors which influence the radical and safe excision of tumor. 4. The results of treatment of residual and recurrent tumors of nasopharynx depend on stage of disease and complexity of excision of the tumor and the worst prognostic factor is intracranial extension of tumor.
    Otolaryngologia polska. The Polish otolaryngology 11/2012; 66(6):397-402.
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: The main purpose of the study was to assess the role and efficacy of high-dose-rate (HDRBT) and pulsed-dose-rate (PDRBT) brachytherapy in the palliative treatment of recurrent or residual stomal tumor after total laryngectomy. STUDY DESIGN: We aimed at presenting a series of 22 consecutive patients treated in the Department of Otolaryngology, Head and Neck Surgery of Poznań University of Medical Sciences, and in the Brachytherapy Department of Greater Poland Cancer Center. METHODS: In 16 patients PDRBT was used and in six patients HDRBT was used. In three patients, BT procedures were performed in combination with simultaneous chemotherapy. Two patients were additionally treated with interstitial hyperthermia. In 16 patients, surgical cytoreduction of the tumor preceded the catheters placement. In six patients, a second course of BT was performed due to neck metastases. All patients were regularly followed up within 6 months. Local control, complications, and survival were assessed. RESULTS: Complete and partial remissions 6 months after finishing the treatment were achieved in four (20%) patients, while survival rates 24 months after BT were estimated for 22%. Severe late complications occurred in two (9%) patients. CONCLUSIONS: The results of our study show that HDRBT and PDRBT are feasible in previously irradiated patients with recurrent or residual stomal tumor after total laryngectomy. They provide acceptable toxicity and good palliative effect.
    The Laryngoscope 09/2012; · 1.98 Impact Factor
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    ABSTRACT: PURPOSE: Evaluation of the donor site efficiency in patients after reconstructive surgery with use of free forearm flap. All patients were treated for oral cavity and larynx cancer. MATERIALS AND METHODS: a group of 21 patients (16 men and 5 women) treated in 2007-2011. The retrospective analysis was conducted on the anamnesis, operating protocols, physical examination and a questionnaire, there was completed by patients during a routine ENT follow up examination. The PRWE (Patient Rated Wrist Evaulation) subjective questionnaire was used to estimate the rate of pain severity and wrist mobility. RESULTS: In 59% of patients the wrist was healed primary, in 36% of patients by granulation. In all patients the wound was healed satisfactory in follow up examination, but 60% of patients revealed extensive scars formation. 62% of patients showed no local pain at rest, while in 38% of them worsening of symptoms was noticed - average 0.5/10 (median 1.0). Pain was more intense in patients who did basic motor activity of hands approximately 1/10 and lifting weights averaging 2.1/10. Dysfunction of the wrist was at the level of the average value of 4.2/50. CONCLUSIONS: Surgical reconstruction with a use of the free forearm flap is associated with the formation of extensive wrist scars. The risk of local complications is low while preserving the qualification protocol, postoperative care and proper surgical management. Reconstructive surgery based on the free forearm flaps gives satisfactory functional results of the donor site. However, it requires surgical experience and practical knowledge of anatomy.
    Otolaryngologia polska. The Polish otolaryngology 09/2012; 66(5):353-358.
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    ABSTRACT: Our aim was to analyse the nature of a sialendoscopy-based classification and present its use in the treatment of stenoses of Wharton's and Stensen's ducts. The classification of stenoses of Wharton's duct has not been published before. We did 133 sialendoscopies in 114 patients who presented with possible obstruction of the ducts to the tertiary centre for ENT at the University Department in Poznań. Twenty-seven patients had their parotid ducts treated, and 24 their submandibular ducts. Suspicion of stenotic changes of the ductal system was suggested during ultrasound examination. They were examined with semirigid endoscopes that enabled direct visualisation of the stenotic areas. A total of 69 stenoses were diagnosed in 51 patients. Stenoses were divided into three groups according to their site. Patients with stenosis of the salivary ducts were treated by dilatation of the stenotic area, intraductal steroid injections, and insertion of a stent for 14-21 days. Forty of the 51 reported considerable improvement, and 7 partial improvement. Four patients had no improvement. Sialendoscopy is a safe way to treat obstruction of the salivary glands. Short and medium term follow up show that it is extremely successful.
    British Journal of Oral and Maxillofacial Surgery 08/2012; · 2.72 Impact Factor
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    ABSTRACT: The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The aim of this study is to assess the effectiveness of sialoendoscopy, rate of salivary fistula or natural ostium stenosis in parotid sialolithiasis treatment. The endpoint was to analyse the efficiency of a combined transcutaneous and endoscopic approach in the removal of refractory and impacted stones in most difficult cases. Study Design: prospective study, tertiary university centre, between XII 2008 and XI 2011, 185 sialendoscopies (SE) were performed in 162 patients. Within the group of 29 patients with parotid sialolithiasis endoscopy was the definite treatment in 15 cases (53 %), in 9 cases lithotripsy (ESWL) was necessary and in 5 patients who failed SE and lithotripsy, a combined approach was performed. This approach comprised both SE and open surgery. We observed no salivary fistula formation after the incision of the duct. Stenosis of the natural ostium thanks to the insertion of stent was observed only in one case. Sialoendoscopy is the method of choice with a high rate of success and gland preservation in small and medium stones. The combined transcutaneous and endoscopic approach is indicated for large stones, for complications after and contraindications in using minimally invasive procedures. Short and medium term follow up shows that surgery can be performed with a high rate of success.
    Archives of Oto-Rhino-Laryngology 08/2012; · 1.29 Impact Factor
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    ABSTRACT: Head and neck squamous cell carcinomas (HNSCC) are characterized by exophytic or endophytic growth. We hypothesized that the growth pattern predicts outcome and associates with distinct clinical and immunological profiles. Tumors obtained from 60 HNSCC patients treated with surgery and adjuvant radiotherapy were identified as exophytic or endophytic. Recurrence-free survival (RFS) at 42 months was determined. In a subsets of 30 patients (22 exophytic and 8 endophytic) tumor stroma and parenchyma were evaluated for infiltrating CD4(+) and CD8(+) T, dendritic, myeloid and FOXP3(+) regulatory T cells (Treg) and expression of immunosuppressive cytokines by immunohistochemistry. The localization and frequency of positive cells were determined microscopically and analyzed by hierarchical clustering to distinguish exophytic versus endophytic tumors. 34/60 patients had exophytic and 26/60 endophytic tumors. No differences in clinicopathologic data, disease progression or RFS were seen between the two cohorts. Infiltrates of CD3(+)CD8(+) T cells were larger in endophytic than exophytic tumors, while FOXP3(+) Treg, TGF-β(+), IL-10(+), Arg-1(+), CD11b(+) cells were equally prominent in both. FOXP3(+) Treg accumulated in endophytic tumor nests, while the exophytic tumor stroma was enriched in IL-10(+) cells (both at p < 0.05). Hierarchical clustering based on immunophenotyping failed to identify different clusters in these two tumor types. However, CD68(+) macrophages and FOXP3(+) Treg showed a distinct distribution. The HNSCC growth pattern did not predict RFS. Although higher numbers and differences in localization of immunosuppressive cells in endophytic versus exophytic tumors were observed, no significant relationship was established between the growth pattern and the immune profile of infiltrating lymphocytes.
    Archives of Oto-Rhino-Laryngology 08/2012; · 1.29 Impact Factor
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    ABSTRACT: OBJECTIVE: Wegener granulomatosis (WG) presents nasal, laryngeal and otologic symptoms as an initial signs of the disease and finally can affect the ENT region in 3/4 patients. The authors want to analyze 7 cases of WG with early aural symptoms, connected with the diagnostics dilemma, discuss the problems of otologic manifestation in WG and present the newest concepts of diagnostics and treatment of this condition. MATERIAL AND METHODS: All patients were treated in the ENT University Department in Poznań in the years 2002-2010. Three patients manifested isolated aural symptoms at the time of the initial clinical presentation (otitis media with effusion, facial palsy and sensorineural profound hypoacusis), whereas in four aural problems were the first, the most expressed and pronounced. In the last four cases neither the initial stage of respiratory nor renal failure were the immediate reason for applying to the doctor, but in two the rapid onset of hypoacusis combined with purulent discharge and facial nerve palsy and in two quick progression of mixed type hypoacusis. RESULTS: The age of the patients ranged from 32 to 46. The outcome of initially otologic cases, which developed generalized form of WG was poor (first died after 2 months, second after 7 days, third in a two-month observation had the pulmonary insufficiency, fourth in one month had severe renal failure), whereas other 3 patients with localized form of the disease have been successfully under control for 3-5 years. CONCLUSIONS: As Wegeners granulomatosis in some cases presents ENT problems as an initial sign, it is important to take it into consideration in atypical inflammatory states of the ear. The otologic onset of WG is very insidious and prompt diagnosis in early stage of disease is a challenge.
    Otolaryngologia polska. The Polish otolaryngology 07/2012; 66(4):254-258.
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    ABSTRACT: AIM OF THE STUDY: To collect and analyze epidemiological and demographical data of patients qualified for and implanted with the Baha® system in Poland. MATERIAL AND METHOD: 17 out of 28 otolaryngology departments performing Baha® implantation in Poland participated in the study. Up to date there were 286 patients registered in database. Data were obtained from the preoperative questionnaires including information such as age and gender, indications for the implantation, previous hearing aid use as well as data regarding the surgical technique. RESULTS: The most frequent indication for the Baha® system was bilateral mixed hearing loss (51%), followed by SSD (18%), bilateral conductive hearing loss (17%), unilateral mixed (8%) and conductive (6%) hearing loss. In 11% of subjects hearing impairment was congenital versus 89% cases of acquired. The mean age was 44 years with the slight prevalence of women (52%). 63% of patients did not have previous experience with hearing aids. The most frequent surgical technique was classic dermatome single stage procedure performed under general anesthesia (65%). CONCLUSIONS: Data gather in this multicentre research serve as a valuable source of information on qualifications for the Baha®, shows demographic spectrum of adult recipients in Poland. It also presents the preferences of surgical procedures. Outcomes of the study may constitute a reference for each centre participating in this research as well as for new centers starting the Baha® procedure.
    Otolaryngologia polska. The Polish otolaryngology 07/2012; 66(4):285-290.
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    Molecular Biology Reports 04/2012; 39(4):5047. · 2.51 Impact Factor

Publication Stats

685 Citations
139.96 Total Impact Points

Institutions

  • 2012–2014
    • Uniwersytet Medyczny im.Karola Marcinkowskiego w Poznaniu
      Posen, Greater Poland Voivodeship, Poland
  • 1996–2014
    • Poznan University of Medical Sciences
      • Department of Otolaryngology Head and Neck Surgery and Laryngological Oncology
      Posen, Greater Poland Voivodeship, Poland
  • 2004–2013
    • Polish Academy of Sciences
      • Institute of Human Genetics
      Warsaw, Masovian Voivodeship, Poland
  • 2003–2012
    • Poznańskie Centrum Superkomputerowo-Sieciowe
      Posen, Greater Poland Voivodeship, Poland
  • 2004–2007
    • Johannes Gutenberg-Universität Mainz
      • • Department of Otolaryngology, Head and Neck Surgery
      • • III. Department of Medicine
      Mainz, Rhineland-Palatinate, Germany
  • 1997
    • Poznan University of Technology
      Posen, Greater Poland Voivodeship, Poland