Skip to main content
Erschienen in: Aesthetic Plastic Surgery 2/2019

31.01.2019 | Original Article

Aesthetic Rhinoplasty and Nasal Obstruction: Presentation of Results of a 100-Patient Study by Using NOSE Inventory

verfasst von: D. Kotzampasakis, T. Delistathi, S. Kotzampasakis, P. Mantalos

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 2/2019

Einloggen, um Zugang zu erhalten

Abstract

Objective

The current prospective study is evaluating the nasal symptoms of patients who underwent aesthetic rhinoplasty with the intranasal approach, in a long-term setting.

Setting

There is a large amount of the literature about the technique, the possible comorbidities, the aesthetic result, the patient’s psychosocial background, but it is very limited regarding the effect of the operation on nasal function and physiology and this is the setting that this study is focusing on.

Materials and Method

The validated NOSE questionnaire (Nasal Obstruction Symptoms Evaluation) was used in 100 patients operated on by surgeons in both the public and private sectors during the period of 2009 and 2016. The results were analyzed statistically by using SPSS.

Results

Classical aesthetic rhinoplasty, without functional interventions (septum or conchas reduction), was found to improve nasal obstruction symptoms postoperatively in various grades: 77% of patients improved, 10% were found unchanged, and 13% reported worsening of their symptoms. Statistical analysis revealed that, in general, the functional outcome is stable with a slight tendency to deteriorate in the following years after operation. Although both genders had improvement in their symptomatology postoperatively, females had a greater improvement than males. Smoking and allergic rhinitis did not appear to be important determinants of the outcome.

Conclusion

Classical aesthetic rhinoplasty appears to improve nasal obstruction symptoms, and this is stable through time. However, limitations apply.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Shiffman M (2013) History of cosmetic rhinoplasty. In: Shiffman MA, Di Giuseppe A (eds) Advanced aesthetic rhinoplasty. Springer, Berlin, pp 133–135CrossRef Shiffman M (2013) History of cosmetic rhinoplasty. In: Shiffman MA, Di Giuseppe A (eds) Advanced aesthetic rhinoplasty. Springer, Berlin, pp 133–135CrossRef
2.
Zurück zum Zitat Rana RE, Arora BS (2002) History of plastic surgery in India. J Postgrad Med 48:76PubMed Rana RE, Arora BS (2002) History of plastic surgery in India. J Postgrad Med 48:76PubMed
3.
Zurück zum Zitat Jo Roe (1989) The deformity termed ‘pug nose’ and its correction by a simple operation. Arch Otolaryngol Head Neck Surg 115(2):156–157CrossRef Jo Roe (1989) The deformity termed ‘pug nose’ and its correction by a simple operation. Arch Otolaryngol Head Neck Surg 115(2):156–157CrossRef
5.
Zurück zum Zitat Ziljker TD, Vuyk H, Adamson P (1993) External incisions in rhinoplasty. Hist Rev Face 2:75–86 Ziljker TD, Vuyk H, Adamson P (1993) External incisions in rhinoplasty. Hist Rev Face 2:75–86
6.
Zurück zum Zitat Kotzampasakis D, Piniara A, Themelis S, Kotzampasakis S, Gabriel E, Maroudias N, Nikolopoulos T (2017) Quality of life of patients underwent aesthetic rhinoplasty. 100 cases assessed with GBI (Glascow benefit inventory). Laryngoscope 10:10. https://doi.org/10.1002/lary.26517 (in press) CrossRef Kotzampasakis D, Piniara A, Themelis S, Kotzampasakis S, Gabriel E, Maroudias N, Nikolopoulos T (2017) Quality of life of patients underwent aesthetic rhinoplasty. 100 cases assessed with GBI (Glascow benefit inventory). Laryngoscope 10:10. https://​doi.​org/​10.​1002/​lary.​26517 (in press) CrossRef
7.
Zurück zum Zitat Yeung A, Hassouneh B, Kim DW (2015) Outcome of nasal valve obstruction after functional and aesthetic-functional rhinoplasty. JAMA Facial Plast Surg 18:128–134CrossRef Yeung A, Hassouneh B, Kim DW (2015) Outcome of nasal valve obstruction after functional and aesthetic-functional rhinoplasty. JAMA Facial Plast Surg 18:128–134CrossRef
8.
Zurück zum Zitat Bulut C, Wallner F, Plinkert PK, Baumann I (2014) Development and validation of the functional rhinoplasty outcome inventory 17 (FROI-17). Rhinology 52(4):315–319CrossRefPubMed Bulut C, Wallner F, Plinkert PK, Baumann I (2014) Development and validation of the functional rhinoplasty outcome inventory 17 (FROI-17). Rhinology 52(4):315–319CrossRefPubMed
9.
Zurück zum Zitat Ross Mobley S, Long J (2016) Extracorporeal septoplasty: assessing functional outcomes using the validated nasal obstruction symptom evaluation score over a 3-year period. Plast Reconstr Surg 137(1):151e–163eCrossRef Ross Mobley S, Long J (2016) Extracorporeal septoplasty: assessing functional outcomes using the validated nasal obstruction symptom evaluation score over a 3-year period. Plast Reconstr Surg 137(1):151e–163eCrossRef
10.
Zurück zum Zitat Boris MB (2007) Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg 6:Doc07 Boris MB (2007) Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg 6:Doc07
11.
Zurück zum Zitat Wexler DB, Davidson TM (2004) The nasal valve: a review of the anatomy, imaging and physiology. Am J Rhinol 18(3):143–150CrossRefPubMed Wexler DB, Davidson TM (2004) The nasal valve: a review of the anatomy, imaging and physiology. Am J Rhinol 18(3):143–150CrossRefPubMed
12.
Zurück zum Zitat Miman MC, Deliktaş H, Ozturan O, Toplu Y, Akarçay M (2006) Internal nasal valve: revisited with objective facts. Otolaryngol Head Neck Surg 134(1):41–47CrossRefPubMed Miman MC, Deliktaş H, Ozturan O, Toplu Y, Akarçay M (2006) Internal nasal valve: revisited with objective facts. Otolaryngol Head Neck Surg 134(1):41–47CrossRefPubMed
13.
14.
Zurück zum Zitat Palesy T, Pratt E, Mrad N, Marcells GN, Harvey RJ (2015) Airflow and patient-perceived improvement following rhinoplastic correction of external nasal valve dysfunction. AMA Facial Plast Surg 17(2):131–136CrossRef Palesy T, Pratt E, Mrad N, Marcells GN, Harvey RJ (2015) Airflow and patient-perceived improvement following rhinoplastic correction of external nasal valve dysfunction. AMA Facial Plast Surg 17(2):131–136CrossRef
15.
Zurück zum Zitat Başer E, Kocagöz GD, Çalim ÖF, Verim A, Yilmaz F, Özturan O (2016) Assessment of patient satisfaction with evaluation methods in open technique septorhinoplasty. J Craniofac Surg 27(2):420–424CrossRefPubMed Başer E, Kocagöz GD, Çalim ÖF, Verim A, Yilmaz F, Özturan O (2016) Assessment of patient satisfaction with evaluation methods in open technique septorhinoplasty. J Craniofac Surg 27(2):420–424CrossRefPubMed
16.
Zurück zum Zitat Carthy M (1990) Plastic surgery, vol 3, 35. W.B. Saunders Company, Philadelphia, p 1817 Carthy M (1990) Plastic surgery, vol 3, 35. W.B. Saunders Company, Philadelphia, p 1817
17.
Zurück zum Zitat Aufricht G (1943) A few hints and surgical details in rhinoplasty. Laryngoscope 53:317CrossRef Aufricht G (1943) A few hints and surgical details in rhinoplasty. Laryngoscope 53:317CrossRef
18.
Zurück zum Zitat Aufricht G (1961) Symposium on corrective rhinoplasty. Plast Reconstr Surg 28:241CrossRef Aufricht G (1961) Symposium on corrective rhinoplasty. Plast Reconstr Surg 28:241CrossRef
19.
Zurück zum Zitat Steward MG, David W, Timothy S, Edward W, Bevan Y, Maureen H (2004) Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130(2):157–163CrossRef Steward MG, David W, Timothy S, Edward W, Bevan Y, Maureen H (2004) Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130(2):157–163CrossRef
20.
Zurück zum Zitat Lachanas VA, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE (2014) Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients. Otolaryngol Head Neck Surg 151(5):819–823CrossRefPubMed Lachanas VA, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE (2014) Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients. Otolaryngol Head Neck Surg 151(5):819–823CrossRefPubMed
21.
Zurück zum Zitat Thiago B, Francini P, Renata P, Michael S, Richard V (2011) Cross-cultural adaptation and validation of a quality of life questionnaire: the nasal obstruction symptom evaluation questionnaire. Rhinology 49:227–231 Thiago B, Francini P, Renata P, Michael S, Richard V (2011) Cross-cultural adaptation and validation of a quality of life questionnaire: the nasal obstruction symptom evaluation questionnaire. Rhinology 49:227–231
22.
Zurück zum Zitat Magali M, Modina M, Stoll D, Ludovic G (2011) French validation of the NOSE and RhinoQOL questionnaires in the management of nasal obstruction. Otolaryngol Head Neck Surg 144(6):988–993CrossRef Magali M, Modina M, Stoll D, Ludovic G (2011) French validation of the NOSE and RhinoQOL questionnaires in the management of nasal obstruction. Otolaryngol Head Neck Surg 144(6):988–993CrossRef
23.
Zurück zum Zitat Lindemann J, Tsakiropoulou E, Konstantinidis I, Lindemann K (2010) Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx 37(3):303–307CrossRefPubMed Lindemann J, Tsakiropoulou E, Konstantinidis I, Lindemann K (2010) Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx 37(3):303–307CrossRefPubMed
24.
Zurück zum Zitat Karatzanis AD, Fragiadakis G, Moshandrea J, Zenk J, Iro H, Velegrakis GA (2009) Septoplasty outcome in patients with and without allergic rhinitis. Rhinology 47(4):444–449PubMed Karatzanis AD, Fragiadakis G, Moshandrea J, Zenk J, Iro H, Velegrakis GA (2009) Septoplasty outcome in patients with and without allergic rhinitis. Rhinology 47(4):444–449PubMed
25.
Zurück zum Zitat Harrill WC, Pillsbury HC, McGuirt WF, Stewart MG (2007) Radiofrequency turbinate reduction: a NOSE evaluation. Laryngoscope 117(11):1912–1919CrossRefPubMed Harrill WC, Pillsbury HC, McGuirt WF, Stewart MG (2007) Radiofrequency turbinate reduction: a NOSE evaluation. Laryngoscope 117(11):1912–1919CrossRefPubMed
26.
Zurück zum Zitat Mondina M, Marro M, Maurice S, Stoll D, de Gabory L (2012) Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires. Eur Arch Otorhinolaryngol 269(10):2189–2195CrossRefPubMed Mondina M, Marro M, Maurice S, Stoll D, de Gabory L (2012) Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires. Eur Arch Otorhinolaryngol 269(10):2189–2195CrossRefPubMed
27.
Zurück zum Zitat Bezerra TF, Stewart MG, Fornazieri MA, Pilan RR, Pinna Fde R, Padua FG, Voegels RL (2012) Quality of life assessment septoplasty in patients with nasal obstruction. Braz J Otorhinolaryngol 78(3):57–62CrossRefPubMed Bezerra TF, Stewart MG, Fornazieri MA, Pilan RR, Pinna Fde R, Padua FG, Voegels RL (2012) Quality of life assessment septoplasty in patients with nasal obstruction. Braz J Otorhinolaryngol 78(3):57–62CrossRefPubMed
28.
Zurück zum Zitat Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT (2004) Outcomes after nasal septoplasty: results from the nasal obstruction septoplasty effectiveness (NOSE) study. Otolaryngol Head Neck Surg 130(3):283–290CrossRef Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT (2004) Outcomes after nasal septoplasty: results from the nasal obstruction septoplasty effectiveness (NOSE) study. Otolaryngol Head Neck Surg 130(3):283–290CrossRef
29.
Zurück zum Zitat Gandomi B, Bayat A, Kazemei T (2010) Outcomes of septoplasty in young adults: the nasal obstruction septoplasty effectiveness study. Am J Otolaryngol 31(3):189–192CrossRefPubMed Gandomi B, Bayat A, Kazemei T (2010) Outcomes of septoplasty in young adults: the nasal obstruction septoplasty effectiveness study. Am J Otolaryngol 31(3):189–192CrossRefPubMed
30.
Zurück zum Zitat Vidigal TDA, Haddad FLM, Gregório LC, Poyares D, Tufik S, Bittencourt LRA (2013) Subjective, anatomical, and functional nasal evaluation of patients with obstructive sleep apnea syndrome. Sleep Breath 17(1):427–433CrossRef Vidigal TDA, Haddad FLM, Gregório LC, Poyares D, Tufik S, Bittencourt LRA (2013) Subjective, anatomical, and functional nasal evaluation of patients with obstructive sleep apnea syndrome. Sleep Breath 17(1):427–433CrossRef
31.
Zurück zum Zitat Saleh AM, Younes A, Friedman O (2012) Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscop 122(2):254–259CrossRef Saleh AM, Younes A, Friedman O (2012) Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscop 122(2):254–259CrossRef
32.
Zurück zum Zitat Islam S, Yousuf A (2016) A comparative analysis of rhinoplasty open vs endonasal approach—our experience. Imp J Interdiscip Res (IJIR) 2(2):386–393 Islam S, Yousuf A (2016) A comparative analysis of rhinoplasty open vs endonasal approach—our experience. Imp J Interdiscip Res (IJIR) 2(2):386–393
33.
34.
Zurück zum Zitat Celebi S, Caglar E, Yilmaz B, Develioglu O, Topak M, Is H, Kulekci M (2014) Does rhinoplasty reduce nasal patency? Ann Otol Rhinol Laryngol 123(10):701–704CrossRefPubMed Celebi S, Caglar E, Yilmaz B, Develioglu O, Topak M, Is H, Kulekci M (2014) Does rhinoplasty reduce nasal patency? Ann Otol Rhinol Laryngol 123(10):701–704CrossRefPubMed
35.
Zurück zum Zitat Faidiga GB, Carenzi LR, Yassuda CC et al (2010) Long-term evaluation in aesthetic rhinoplasty in an academic referral center. Braz J Otorhinolaryngol 76(4):437–441CrossRefPubMed Faidiga GB, Carenzi LR, Yassuda CC et al (2010) Long-term evaluation in aesthetic rhinoplasty in an academic referral center. Braz J Otorhinolaryngol 76(4):437–441CrossRefPubMed
36.
Zurück zum Zitat Guyuron B, Bokhari F (1996) Patient satisfaction following rhinoplasty. Aesthet Plast Surg 20(2):153–157CrossRef Guyuron B, Bokhari F (1996) Patient satisfaction following rhinoplasty. Aesthet Plast Surg 20(2):153–157CrossRef
37.
Zurück zum Zitat Baumann I (2010) Quality of life before and after septoplasty and rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 9:1–12 Baumann I (2010) Quality of life before and after septoplasty and rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 9:1–12
38.
39.
Zurück zum Zitat Arima LM, Velasco LC, Tiago RS (2011) Crooked nose: outcome evaluations in rhinoplasty. Braz J Otorhinolaryngol 77(4):510–515CrossRefPubMed Arima LM, Velasco LC, Tiago RS (2011) Crooked nose: outcome evaluations in rhinoplasty. Braz J Otorhinolaryngol 77(4):510–515CrossRefPubMed
40.
Zurück zum Zitat Erdogan BA, Avseren E, Paksoy M, Bora F, Altin G (2013) Assessing quality of life in septorhinoplasty patients with two different instruments. B ENT 9(4):277–283PubMed Erdogan BA, Avseren E, Paksoy M, Bora F, Altin G (2013) Assessing quality of life in septorhinoplasty patients with two different instruments. B ENT 9(4):277–283PubMed
41.
Zurück zum Zitat Bensoussan Jean-Charles, Bolton Michael A, Pi Sarah, Powell-Hicks Allycin L, Postolova Anna, Razani Bahram, Reyes Kevin, IsHak Waguih William (2014) Quality of life before and after cosmetic surgery. CNS Spectr 19:282–292CrossRefPubMed Bensoussan Jean-Charles, Bolton Michael A, Pi Sarah, Powell-Hicks Allycin L, Postolova Anna, Razani Bahram, Reyes Kevin, IsHak Waguih William (2014) Quality of life before and after cosmetic surgery. CNS Spectr 19:282–292CrossRefPubMed
42.
Zurück zum Zitat Sarwer DB, Infield AL, Baker JL et al (2008) Two-year results of a prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthet Surg J 28(3):245–250CrossRefPubMed Sarwer DB, Infield AL, Baker JL et al (2008) Two-year results of a prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthet Surg J 28(3):245–250CrossRefPubMed
43.
Zurück zum Zitat Lazar CC, Clerc I, Deneuve S, Auquit-Auckbur I, Milliez PY (2009) Abdominoplasty after major weight loss: improvement of quality of life and psychological status. Obes Surg 19(8):1170–1175CrossRefPubMed Lazar CC, Clerc I, Deneuve S, Auquit-Auckbur I, Milliez PY (2009) Abdominoplasty after major weight loss: improvement of quality of life and psychological status. Obes Surg 19(8):1170–1175CrossRefPubMed
44.
Zurück zum Zitat Cintra W Jr, Modolin ML, Gemperli R et al (2008) Quality of life after abdominoplasty in women after bariatric surgery. Obes Surg 18(6):728–732CrossRefPubMed Cintra W Jr, Modolin ML, Gemperli R et al (2008) Quality of life after abdominoplasty in women after bariatric surgery. Obes Surg 18(6):728–732CrossRefPubMed
45.
Zurück zum Zitat Robin LW (2012) Disease specific quality of life outcomes in functional rhinoplasty. Laryngoscope 122:1480–1488CrossRef Robin LW (2012) Disease specific quality of life outcomes in functional rhinoplasty. Laryngoscope 122:1480–1488CrossRef
Metadaten
Titel
Aesthetic Rhinoplasty and Nasal Obstruction: Presentation of Results of a 100-Patient Study by Using NOSE Inventory
verfasst von
D. Kotzampasakis
T. Delistathi
S. Kotzampasakis
P. Mantalos
Publikationsdatum
31.01.2019
Verlag
Springer US
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 2/2019
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-019-01316-6

Weitere Artikel der Ausgabe 2/2019

Aesthetic Plastic Surgery 2/2019 Zur Ausgabe

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.