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Otolaryngology: Otolaryngology. Treatment

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, which is characteristic mainly for boys and young men. Structurally, it is composed of the fibrous tissue and thin-walled vessels, which are bleeding from time to time. The tumor is characterized by an aggressive course. Depending on the growth direction, over time it grows into the nasal cavity, paranasal sinuses and skull base, creating a threat to the patient’s life. The major treatment option is surgery. In some cases, the radiation techniques may be used.
Surgery

The choice of the surgical technique depends on the formation size:

  1. For small tumors, surgery can be performed endoscopically through the natural orifices (mouth or nose). Such an intervention can minimize the tissue trauma.
  2. Another option of removing small JNA is through the palate. The surgeon makes a horseshoe-shaped incision on the upper edge of the gums, excises a portion of the palate on the affected side, and then resects the tumor. Such an access provides a broad overview of the nasopharynx.
  3. Medial tumors, which invaded the nasal cavity or orbit, are removed through the maxillary sinus. The incision in this case is made under the upper lip.
  4. Large JNA, invading the base of the skull, are dissected through the infratemporal fossa.

The day before surgery, the angiography is performed, which allows the embolization (occlusion) of blood vessels feeding the tumor and reduces the risk of bleeding.

JNA is removed to the fullest extent possible. If the total resection is not possible, the formation is excised partially, and the patient is prescribed radiation therapy after surgery. The following techniques are well-proven for angiofibromas:

  1. Stereotactic surgery (Gamma Knife). The tumor residue is affected by a high dose of radiation, which leads to the tumor cell death. The flows of radiation particles are formed so that most of the energy was targeted at the pathological focus. Thus, the healthy tissue is almost not subjected to irradiation. The procedure is performed only once. The effect is manifested over the next 6 to 24 months.
  2. Conformal radiotherapy. The tumor is irradiated precisely from different angles. Consequently, the major impact is targeted exactly at the pathological focus. The surrounding tissues are damaged to a lesser extent than upon conventional irradiation techniques. The sessions are repeated daily for several weeks.

For inoperable JNA, the radiation techniques may be indicated as the main treatment option.

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Tel Aviv Sourasky Medical Center

9.9/10 from 23 Votes

Department of Otolaryngology, Head and Neck Surgery

The Department of Otolaryngology, Head and Neck Surgery at the Tel Aviv Sourasky Medical Center specializes in the diagnosis and treatment (surgical or conservative) of diseases affecting the ears, nose, paranasal sinuses, throat, mouth, pharynx, head and neck.


location_onCountry: Israel
location_searchingCity: Tel Aviv

Hannover Medical School

9.8/10 from 43 Votes

Department of Otolaryngology

The Department of Otolaryngology at the Hannover Medical School has a special expertise in diagnosis and treatment of diseases in the area of ear, nose and throat medicine.


location_onCountry: Germany
location_searchingCity: Hannover
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Marienhaus Klinikum St. Elisabeth Neuwied

9.8/10 from 23 Votes

Department of Otolaryngology

The Department of Otolaryngology at the Marienhaus Klinikum St. Elisabeth Neuwied works in close cooperation with a private otolaryngology office of Dr. med. Joachim Hammer. There are performed all operations of minor and medium ENT surgery.


location_onCountry: Germany
location_searchingCity: Neuwied

District Hospital Waldbröl Oberberg

9.7/10 from 23 Votes

Department of Otolaryngology, Plastic Surgery, Facial Surgery

The Department of Otolaryngology at the District Hospital of Waldbröl provides conservative and surgical treatment of all diseases of ear (including hearing improvement), nose, paranasal sinuses, larynx and neck. The surgery is performed on the outpatient basis.


location_onCountry: Germany
location_searchingCity: Waldbrоl

Hospital Gummersbach Oberberg

9.6/10 from 23 Votes

Department of Otolaryngology, Facial Plastic Surgery, Head and Neck Cancer

The Department of Otolaryngology, Facial Plastic Surgery, Head and Neck Cancer offers medical care meeting the latest medical achievements and with the use of all diagnostic and surgical capabilities available this field.


location_onCountry: Germany
location_searchingCity: Gummersbach

University Hospital Düsseldorf

9.5/10 from 71 Votes

Department of Otolaryngology

The Department of Otolaryngology at the University Hospital Dusseldorf offers the full range of modern medical service in the field of otolaryngology and related disciplines. The Department offers You medical care of international standards with the latest diagnosis and treatment capabilities.


location_onCountry: Germany
location_searchingCity: Duesseldorf

University Hospital Giessen UKGM

9.5/10 from 35 Votes

Department of Otolaryngology, Head and Neck Surgery and Plastic Surgery

As a center of maximum medical care, the Department of Otolaryngology at the University Hospital Giessen covers the entire spectrum of otolaryngology at the highest possible level.


location_onCountry: Germany
location_searchingCity: Giessen

Academic Hospital Hildesheim

9.5/10 from 23 Votes

Department of Otolaryngology

The Department of Otolaryngology at the Academic Hospital Hildesheim performs not only head and neck surgery, but also treats neurosurgical diseases in this field. The department offers ENT treatment at the highest medical level. It also specializes in the implantation of auditory systems (active middle ear implants).


location_onCountry: Germany
location_searchingCity: Hildesheim

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Head physician:

Dr. med. Adrian MünscherCurriculum vitae keyboard_arrow_down

Personal data Born 3/3/1960, married, living in Hamburg, Germany and Training Qualifications

  • 1979-1986 Medical Schools: Heidelberg and Freiburg, Germany
  • 1986 Doctor's Licence
  • 1986 Thesis "Dr.med." degree, University of Heidelberg, Germany graded with "Magna cum laude" 
  • 1986-1988 Residency Department general and surgical Pathology, University of Mainz, Germany
  • 1988-2008 Residence of Fellowship Department of Otolaryngology, Head and Neck Surgery and Oncology, University of Frankfurt, Germany
  • 1992 Specialist in Otorhinolaryngology, Head and Neck Surgery
  • 1994 Specialist in Plastic Surgery of the Head and Neck 
  • 1996 Specialist in Special Head and Neck Surgery
  • 1997 Specialist in Allergology
  • 2007 Specialist in Medicinial Tumor Therapy (Chemotherapy and Target Therapy)
  • 1998 Thesis for "PD Dr. med. Habil" and PhD Venia legendi Appointment as "Privatdozent"
  • 1994 Appointment as "Assistent medical director"
  • 2004 Appointment as "Professor"
  • 1999 Appointment as "Vice Chair of the Clinic"
  • 2008 Appointment as Chair of the Clinic for Otolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg (UKE)
  • 1986-1988 Scientific residencies at MDA Houston (USA) and Sloan Kettering Cancer Center New York (USA)

Memberships and functions in Medical societies and academic boards

  • German Society of Otolaryngology, Head and Neck Surgery and it's Oncology Group American Academy of Otolaryngology, Head and Neck Surgery German Cancer Society National Genome research project ASCO, ESMO, ESSO, EORTC, EUFOS, AHNS, EHNS, IFHNOS
  • Member of the Steering Board of the EORTC, Head and Neck Group
  • Founder and Chair of the German Society for the prevention and for the Sponsorhip of research in laryngeal cancer
  • Founder of the "International Cancer Network"

Academic and Clinical focus

  • Author of more than 150 papers on the topic of head and neck and other cancers publicated in international peer-reviewed journals 
  • Investigator and PI in 32 Clinical Studies
  • Board and Advisory Boards in numerous national and international peer-reviewed journals and research committees
  • Special surgical work includes endoscopic surgery, reconstructive tumor and tracheal surgery as well as functional laryngeal surgery. Also trained in medical oncology work on induction chemotherapy and targeted therapy drawing the line between surgical and nonsurgical approaches in multimodal tumor therapy

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University Hospital Hamburg-Eppendorf

9.2/10 from 92 Votes

Department of Otolaryngology and Head-Neck Surgery

The Department of Otolaryngology, Head and Neck Surgery at the University Medical Center Hamburg-Eppendorf uses the latest technology to treat patients with any otolaryngological diseases.


location_onCountry: Germany
location_searchingCity: Hamburg
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Head physician:

Prof. Dr. med. Alexander BerghausCurriculum vitae keyboard_arrow_down

  • 1970 bis 1976 Studium der Humanmedizin an der Universität des Saarlandes in Homburg, der Rheinischen Friedrich-Wilhelms-Universität in Bonn und an der Freien Universität Berlin.
  • 1976 Staatsexamen.
  • 1976 bis 1978 Medizinalassistent.
  • 1978 Approbation als Arzt; Wissenschaftlicher Assistent an der Hals-Nasen-Ohren-Klinik des Klinikum Steglitz (jetzt Klinikum Benjamin Franklin) der Freien Universität Berlin.
  • 1981 Promotion zum „Dr. med.“.
  • 1981 bis 1983 Mehrere Studienaufenthalte zur Fortbildung in der rekonstruktiven Kopf-Hals-Chirurgie, u.a. bei Prof.Dr. R. Meyer (Lausanne), Prof. Dr. M.E. Tardy (Chicago) und Prof. Dr. J.J. Conley (New York).
  • 1983 Oberarztfunktion. Halbjährige Weiterbildung in Audiologie und Phoniatrie.
  • 1984 Anerkennung als "Arzt für Hals-Nasen-Ohren-Heilkunde" mit Genehmigung zur Führung der Zusatzbezeichnung "Stimm- und Sprachstörungen".
  • 1986 Habilitation zum „Privatdozent“. Auszeichnung mit dem Hans-von-Seemen-Preis der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie.
  • Leitender Oberarzt, HNO-Klinik des Klinikum Steglitz, Berlin.
  • 1988 Genehmigung zur Führung der Zusatzbezeichnung "Plastische Operationen".
  • 1989 Stipendium der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde für eine Informationsreise über die rekonstruktive Kopf-Hals-Chirurgie an US-amerikanischen Universitätskliniken (u. a. in New York, St. Louis, Seattle, Los Angeles, San Diego).
  • 1990 Ernennung zum Universitätsprofessor (C3) an der Freien Universität Berlin. 
  • Weiterbildungsermächtigung "Plastische Operationen" durch die Ärztekammer Berlin. 
  • 1993 Direktor der Klinik für Hals-Nasen-Ohrenkrankheiten, Gesichts- und Halschirurgie an der Martin-Luther-Universität Halle-Wittenberg.
  • 1994 Studiendekan der Medizinischen Fakultät der Martin-Luther-Universität Halle-Wittenberg.
  • 1995 Präsident der 33. Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie in Halle / Saale.
  • 1996 Prodekan der Medizinischen Fakultät der  Martin-Luther-Universität Halle-Wittenberg (bis 1998)
  • 1999 Wahl zum Fachgutachter der Deutschen Forschungsgemeinschaft (DFG)
  • 2000 Wahl in das internationale Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum (CORLAS)
  • 2001 Präsidiumsmitglied der Deutschen Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie
  • Aufnahme in die Deutsche Akademie der Naturforscher LEOPOLDINA
  • 2003 Direktor der Klinik für Hals-Nasen-Ohrenheilkunde der LMU München.
  • 2006 / 2007 Präsident der Deutschen Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie. Leitung der 78. Jahrestagung der Gesellschaft in München.
  • 2011 Vorstandsvorsitzender des Vereins der Freunde und Förderer des Klinikums der LMU München

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University Hospital of the Ludwig-Maximilians-University Munich

9.2/10 from 40 Votes

Department of Otolaryngology

The Department of Otolaryngology offers outpatient and inpatient care. For this purpose, it has 102 beds and two large departments.


location_onCountry: Germany
location_searchingCity: Munich

University Hospital Tubingen

9.2/10 from 55 Votes

Department of Otolaryngology

The Department of Otolaryngology at the University Hospital Tubingen has 64 beds in three stations and an intensive care unit. About 40,000 patients are treated on the inpatient basis every year.


location_onCountry: Germany
location_searchingCity: Tuebingen

Leech Private Clinic

9.2/10 from 7 Votes

Department of Otolaryngology

All standard ENT operations are conducted in the Clinic of Leech. The principal objective and direction of the head and neck operations are the following surgical methods: endoscopic, endonasal operations in the sinus in case of chronic illnesses of the air cells (polypus), functional and esthe...


location_onCountry: Austria
location_searchingCity: Graz

DKD HELIOS Clinic Wiesbaden

9.2/10 from 5 Votes

Department of Otolaryngology

The practice of Otorhinolaryngology of the DKD HELIOS Klnik Wiesbaden has the modernist equipment, and offers comprehensive diagnostic, countseling and therapy in the field of diseases of the nose, throat and ear.


location_onCountry: Germany
location_searchingCity: Wiesbaden

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Head physician:

Prof. Dr. med. Friedrich BootzCurriculum vitae keyboard_arrow_down

  • 1973-1976 Studium der Medizinischen Informatik in Heidelberg,
  • 1976-1981 Studium der Humanmedizin in Tübingen, anschließend Praktisches Jahr am Kreiskrankenhaus in Friedrichshafen
  • 1982 Approbation sowie Promotion zum Dr. med. an der Universität Tübingen (Thema: Modifizierbarkeit von Reflexantworten bei der Kompensation von raschen Körperauslenkungen)
  • 1982 Beginn der Weiterbildung Hals- Nasen- Ohrenheilkunde an der Universitäts-HNO-Klinik Tübingen bis 1988 unter Prof. Dr. D. Plester, ab 1988 unter Prof. Dr. H. P. Zenner
  • 1986-1987 Senior Registrar am Departement of Otolaryngology der Universität in Liverpool (Direktor: Prof. P.M. Stell)
  • 1987 Anerkennung als Hals-Nasen-Ohrenarzt und Ernennung zum diensttuenden Oberarzt der Univ.-HNO-Klinik in Tübingen
  • 1989-1995 Leitender Oberarzt der Univ.-HNO-Klinik in Tübingen
  • 1990 Verleihung der Zusatzbezeichnung "Plastische Operationen"
  • 1991 Habilitation (Thema: Freie Transplantation von respiratorischem Epithel - eine experimentelle Untersuchung) und Verleihung der Lehrbefugnis für das Fach Hals-Nasen-Ohrenheilkunde
  • 1995 Erlangung der fakultativen Weiterbildung „Operative HNO-Heilkunde"
  • 1995 Berufung auf den Lehrstuhl HNO-Heilkunde der Universität Leipzig, Ernennung zum Universitätsprofessor
  • 1995 Erteilung der Befugnis zur Weiterbildung für das Gebiet Hals-Nasen-Ohrenheilkunde, den Bereich Plastische Operationen und die Fakultative Weiterbildung Spezielle HNO-Chirurgie durch die Sächsische Landesärztekammer
  • 2002 Berufung auf den Lehrstuhl HNO-Heilkunde der Universität Bonn
  • 2008 Ernennung zum Visiting Professor (Profesor Invitat) der Medizinischen Fakultät der Universität Victor Babeş in Timişoara, Rumänien
  • 2010 Verleihung der Ehrendoktorwürde durch die Universität Victor Babeş in Timişoara, Rumänien
  • 2014 Förderpreis der Professor Dr. Ludwig Haymann-Stiftung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf-und Hals-Chirurgie

 

University Hospital Bonn

9.2/10 from 150 Votes

Department of Otolaryngology

The Department of Otolaryngology, Head and Neck Surgery at the University Hospital Bonn under the direction of Prof. Dr. med. Dr. h.c. F. Bootz offers the entire spectrum of conservative therapeutic and surgical otolaryngology and surgery at a modern university level. .


location_onCountry: Germany
location_searchingCity: Bonn

University Hospital Erlangen

9.1/10 from 51 Votes

Department of Otolaryngology, Head and Neck Surgery

The Department of Otolaryngology, Head and Neck Surgery at the University Hospital Erlangen belongs to the largest ENT departments in Germany with its 80 approved beds, 6 operating rooms, an Intensive Care Unit with 5 beds and a university outpatient clinic with 9 wards.


location_onCountry: Germany
location_searchingCity: Erlangen
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