Prof. Dr. Dr. Dr. Dr. h.c.   MD DMD MA

Emeka NKENKE

Oral and Maxillofacial Surgery

Vienna

PROFESSIONAL PROFILE

Prof. Nkenke is Professor and Head of the Department of Oral and Maxillofacial Surgery of the General Hospital of Vienna, Austria. He is also a consultant to the Wiener Privatklinik and runs a private practice. Prof. Nkenke is dually qualified as a doctor as well as a dentist. He also holds a doctorate in theoretical medicine. Prof. Nkenke has a deep commitment to innovation when he practices oral and maxillofacial surgery. He uses the latest technology to the benefit of his patients. He is specialized in virtual surgical planning and the use of patient-specific implants in orthognathic surgery, craniofacial surgery and reconstructive surgery. Prof. Nkenke has pioneered guided dental implant surgery. Further evidence of his commitment to innovation are new techniques he pioneered on free flap jaw reconstruction for cancer patients. This is a microsurgical technique which enables large defects in the face and jaws to be repaired.

Prof. Nkenke has a special dedication to the treatment of cleft lip and palate malformations. Since two decades he is performing primary (closure of lip and palate) and secondary (bone grafting of the maxilla, rhinoplasty, advancement of the maxilla) operations. His armamentarium also includes distraction osteogenesis.

Prof. Nkenke holds the positions of the Editor-in-Chief of the Journal of Cranio-Maxillofacial Surgery and a Section Editor of the International Journal Oral and Maxillofacial Surgery.

He is also active in undergraduate and postgraduate education. Prof. Nkenke give webinars on a regular basis. He has run several national and international congresses.

CURRICULUM VITAE

Univ.-Prof. Dr. med. Dr. med. dent. Dr. rer. medic. Dr.h.c. Emeka Nkenke, MD, DMD, MA
Professional positions
2019 - present
Editor-in-chief of the Journal of Cranio-Maxillofacial Surgery
2014 - present
Professor and Head of the Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Austria
2014
Professor and Head of the Department of Oral and Maxillofacial Surgery, Halle University Hospital, Germany
2009 - 2014
Full Professor of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany
2004-2009
Associate Professor of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany

CLINICAL INTERESTS

Bisphosphonate related osteonecrosis

Today there are numerous conditions that might require the administration of antiresorptive medication. Osteoporosis, chronic recurrent multifocal osteomyelitis and bony metastases of malignant tumors are examples. Typical examples of this kind of medication are Denusomab (e.g. Prolia, Xgeva) or bisphosphonates (e.g. Fosamax, Bonviva, Zometa). An important adverse effect is the development of an osteonecrosis of the jaws that is characterized by exposed bone, halitosis, pain and pus formation. The treatment of this condition is dependent on the extent of the osteonecrosis and the general health condition of the patient. Whenever possible a conservative approach is adopted that avoids surgery. However, sometimes the removal of the necrotic bone might become necessary.

Bone grafting

Pronounced resorption of the jaw (arrow)
Virtual planning of the bone reconstruction procedure
Patient-specific artificial bone block
The artificial bone block does fit in the defect, precisely
The postoperative x-ray shows the bone block fixed to the jaw with two screws
Distraction device installed at an atrophied region of the lower jaw
Distraction procedure increases bone height
Dental implants placed after removal of distraction device
Bridgework is fixed to dental implants

The placement of dental implants is a very effective approach to restore chewing function. Teeth might get lost due to trauma, periodontal disease or trauma. Especially, when a trauma has occurred the aim is to place implants immediately to prevent bone resorption. However, often the bone volume will be inadequate in the regions where implants are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient. After a healing period of approximately 3 months the implants will be restored with artificial crowns.

Cleft lip and palate surgery

Naso-alveolar molding device for improving the symmetry of the nose before surgery
Situation after lip closure
Situation after lip closure
Situation after lip closure

Since more than two decades Prof. Nkenke is practicing cleft lip and palate surgery. He is performing the closure of the lip as well as the palate on a regular basis. Naso-alveolar molding is included in the treatment concept. Typically, the lip repair is performed by the end of the third month while the repair of the palate can start from the 6 th month on. At an age of around 11 years also additional bone grafting of the alveolar cleft might become necessary. In order to offer a comprehensive treatment approach, Prof. Nkenke is has built an interdisciplinary team (otorhinolaryngologist, speech pathologist, orthodontist, pediatric dentist, psychologist) that can handle all the issues that children with the given malformation and their parents might come across. Prof. Nkenke also has specialized in secondary corrections. These include rhinoplasty, corrective surgery to the lip and advancement of the maxilla.

Craniofacial surgery

Patient suffering from Crouzon‘s syndrome with pronounced retroposition of the midface
Virtual planning of the position of the internal distraction device
Only the small part for the activation of the distraction device is visible above the ear
Final position of the midface at the end of the distraction period
Unobtrusive facial profile after midfacial distraction
Trigonocephaly is characterized by a triangle-shaped forehead
The treatment is based on the contouring of the bone of the forehead - Typically, surgery is performed at the age of 6 months
The treatment is based on the contouring of the bone of the forehead - Typically, surgery is performed at the age of 6 months
In a 5-year old patient the distance between the eyes istoo wide (hypertelorism)
The surgery is planned, virtually
The surgery combines the correction of the positions of the eyes (light blue and green) and an advancement of a part of the forehead (dark blue; frontoorbital advancement).

Prof. Nkenke treats craniomalformations like craniosynostosis (e.g. oxycephaly, plagiocephaly, skaphocephaly, trigonocephaly) in an interdisciplinary team together with a neurosurgeon. Depending on the complexity he might choose to perform virtual surgical planning and the use of surgical cutting guides for the reshaping of the cranial vault. Patients who suffer from M. Apert or M. Crouzon often suffer from a hypoplastic midface resulting in the inability to close the eyes completely and problems with breathing that sometimes even can cause sleep apnea. Midfacial advancement on the LeFort III level solves these issues. Prof. Nkenke performs computerized planning of these interventions on a regular basis. It is well known that the most stable result of the advancement of the midface is achieved by distraction osteogenesis. Therefore, Prof. Nkenke performs this kind of surgery with buried internal distraction devices that are almost invisible and do not impair the social activities of the child.

Cysts

The x-ray shows a large cystic defect of the lower jaw with a tooth that cannot erupt
In order to allow spontaneous eruption of the tooth, the cyst is opened up (decompression)
After a few weeks the tooths starts to erupt, spontaneously
After 6 months the cystic defect has reduced in size significantly, while the tooth has found its correct position

Several different conditions can cause cysts. These cysts can be the consequence of delayed eruption of teeth, of infections or benign or sometimes even malignant tumors. By harvesting biopsies benign and malignant tumors have to be ruled out. In the next step depending on the size of the cyst a decompression (cystostomy) will be performed. This approach allow for spontaneous bony regeneration of the cystic lesion and reduces the risk of damaging of adjacent structures like teeth or nerves to a minimum. An alternative is the complete removal of the cyst (cystectomy) that might also include filling of the defect with autogenous bone or bone substitutes. Depending on the clinical and radiological presentation of the individual case the treatment concept will be chosen.

Distraction osteogenesis

Adult patient with cleft malformation suffering from an incorrect postion of the upper jaw
Distraction devices installed
Distraction devices are installed within the upper jaw, invisible to the outside
The upper jaw is advanced until the correct position is achieved
After complete healing the distraction devices are removed
As a consequence of trauma to the temporomandibular joints(TMJ) the patient is suffering from a small lower jaw and an open bite
Distraction devices are installed at the ascending ramus of the mandible, bilaterally
Gradually, the ascending ramus is lengthened, bilaterally
At the end of the distraction period the open bite is gone and the mandible has gained a normal size
At the end of the distraction period the open bite is gone and the mandible has gained a normal size

Prof. Nkenke uses distraction osteogenesis as an alternative to conventional bone grafting when a bony defect has to be filled. He also adopts this technique in craniofacial surgery and orthognathic surgery when a pronounced advancement of the maxilla is needed. Depending on the complexity of the procedure Prof. Nkenke will choose computerized planning and patient specific distraction devices. Distraction osteogenesis yields stable results and avoids harvesting of bone from additional surgical sites.

Facial fractures

The patient suffers from a fracture of the left orbital floor
For a maximum of precision of the reconstruction of the orbital floor a computerized virtual planning of the surgery is performed and a patient specific titanium plate (arrow) is fabricated that fits in the defect, precisely
Within a few days the patient specific titanium plate is available for the surgery
Based on the computerized planning a precise symmetric reconstruction is achieved

Fractures of the facial bone typically occur as a result of trauma especially during sports or conventional falls. The fractures can affect mandible as well as maxilla. Typically, the treatment should be performed as soon as possible. It includes the reduction of the fracture and its stabilization by titanium plates and screws. Today in most of the cases there is no need to restrict mouth opening after the surgery by maxillo-mandibular fixation. For cases of fractures of the orbital floor Prof. Nkenke recommends the use of individually planned, prefabricated, patient specific metal sheets for reconstruction. If a fracture should have healed in an inadequate position because there was no possibility to treat the fracture adequately, when it happened, Prof. Nkenke will be happy to correct the shape of the jaw and to bring it back to a position where the patient will be able chew again in a normal way.

Implant dentistry

Clinical crown of the lateral incisor lost as a consequence of trauma
Dental implant is placed using the socket shield technique
A provisional artificial crown can be placed on the implant immediately

The placement of dental implants is a very effective approach to restore chewing function. Teeth might get lost due to trauma, periodontal disease or trauma. Especially, when a trauma has occurred the aim is to place implants immediately to prevent bone resorption. However, often the bone volume will be inadequate in the regions where implants are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient. After a healing period of approximately 3 months the implants will be restored with artificial crowns.

Medication related osteonecrosis

Today there are numerous conditions that might require the administration of antiresorptive medication. Osteoporosis, chronic recurrent multifocal osteomyelitis and bony metastases of malignant tumors are examples. Typical examples of this kind of medication are Denusomab (e.g. Prolia, Xgeva) or bisphosphonates (e.g. Fosamax, Bonviva, Zometa). An important adverse effect is the development of an osteonecrosis of the jaws that is characterized by exposed bone, halitosis, pain and pus formation. The treatment of this condition is dependent on the extent of the osteonecrosis and the general health condition of the patient. Whenever possible a conservative approach is adopted that avoids surgery. However, sometimes the removal of the necrotic bone might become necessary.

Microvascular surgery

The patient is suffering from a tumor on the left side of the upper jaw
Removal of the tumor and immediate reconstruction of the maxilla including dental implants with bone from the lower leg(fibula) are planned on3D models
After the reconstruction the dental treatment can start to allow normal chewing as soon as possible
A bar is installed on the implant
Natural looking teeth complete the reconstruction
After removal of the tumor from the mandible the jaw is reconstructed with bone from the lower leg
After a healing period of 3 months the stabilizing metal plates can be removed and dental implants are placed to allow normal chewing

Reconstructive surgery of the head and neck is performed to close bony and/or soft tissue defects that can be present as the consequence of trauma or tumors. The aim is to restore function (e.g. speech, chewing, swallowing) and an unobtrusive facial appearance. Different bone grafts and soft tissue grafts can be harvested from different regions of the body and will be transferred to the defect. Sometimes free flaps have to be adopted that require microvascular surgery in order to secure an independent vascularization of the flaps. Prof. Nkenke has specialized in this kind of surgery and is happy to provide a comprehensive planning of the surgery (including computerized techniques) and patient specific implants in order to come as close as possible to the situation before the defect occurred.

Periodontal surgery

A certain percentage of the population is prone to bone resorption around the natural teeth as a consequence of chronic infection. Patients typically suffer from mobile teeth, pain, swelling of the gums and pus formation. The aim of periodontal surgery is the removal of the infection and the reconstruction of the bone in order to restore stability of the teeth. Depending on the severity of the disease the surgery can be performed under local anesthesia. If there should be a generalized pronounced infection, general anesthesia is recommended.

Preprosthetic surgery

Distraction device installed at an atrophied region of the lower jaw
Distraction procedure increases bone height
Dental implants placed after removal of distraction device
Bridgework is fixed to dental implants

The placement of dental implants is a very effective approach to restore chewing function. However, sometimes the bone volume is inadequate to place the implants where they are needed. In these cases there is a need for bone augmentation procedures in order to facilitate implant placement. Today there are numerous different approaches to bone augmentation that have to be selected carefully. Autogenous bone or artificial bone substitutes might be chosen for the procedures. Implants can be placed immediately or after a healing period of the bone grafts of some months. Depending of the individual patient case also computerized planning and the adoption of guided implant surgery can make sense in order to make this kind of surgery as comfortable as possible for the patient.

Reconstructive surgery

The patient is suffering from a tumor on the left side of the upper jaw
Removal of the tumor and immediate reconstruction of the maxilla including dental implants with bone from the lower leg(fibula) are planned on3D models
After the reconstruction the dental treatment can start to allow normal chewing as soon as possible
A bar is installed on the implant
Natural looking teeth complete the reconstruction
After removal of the tumor from the mandible the jaw is reconstructed with bone from the lower leg
After a healing period of 3 months the stabilizing metal plates can be removed and dental implants are placed to allow normal chewing

Reconstructive surgery of the head and neck is performed to close bony and/or soft tissue defects that can be present as the consequence of trauma or tumors. The aim is to restore function (e.g. speech, chewing, swallowing) and an unobtrusive facial appearance. Different bone grafts and soft tissue grafts can be harvested from different regions of the body and will be transferred to the defect. Sometimes free flaps have to be adopted that require microsurgery in order to secure an independent vascularization of the flaps. Prof. Nkenke has specialized in this kind of surgery and is happy to provide a comprehensive planning of the surgery (including computerized techniques) and patient specific implants in order to come as close as possible to the situation before the defect occurred.

Salivary gland surgery

The salivary glands (parotid gland, submandibular gland, sublingual gland) can be affected by a number of different problems. Especially, pain and swelling can bother the patient. Also there can be benign and malignant tumors that need close attention. Depending on the individual condition of the patient Prof. Nkenke is happy to offer the adequate treatment that might be endoscopically or might require partial or total removal of the gland.

Sinus surgery

The patient is suffering from a chronic sinusitis of the maxilla. As a consequence, only a minimal amount of air (arrow) is present in the sinus
After adequate surgery normal pneumatization of the maxillary is re-established

The maxillary sinus often is affected by infections. Depending on the cause of infections different approaches have to be chosen to fix the problem. Especially, it is necessary to rule out dental causes for the infection. Prof. Nkenke is able to perform the surgery endoscopically or to choose a different approach depending on the cause of the condition.

Sleep apnea

The patient is suffering from sleep apnea as a consequence of a reduced width of the posterior airway space (arrow)
After simultaneous advancement of upper and lower jaw (rotation advancement) the width of the posterior airway space (arrow) is increased, significantly, and sleep apnea is gone

Sleep apnea is a complex condition that impairs quality of life, seriously. There are different treatment options that also include the hypoglossal nerve stimulator. Prof. Nkenke is glad to offer a wide spectrum of treatment approaches, but stresses the value of bimaxillary advancement of the jaws by rotation advancement. This kind of surgery can be performed at any age and still is one of the safest options for the treatment of sleep apena. The patients feel an immediate postoperative effect because the apnea episodes are reduced close to zero.

Skin cancer surgery

Prof. Nkenke has specialized in esthetic facial surgery and, therefore, is able to provide comprehensive skin cancer surgery. The aim is to remove the tumor completely while leaving the facial appearance unobtrusive. Depending on the size of the tumor and the patient’s individual tendency towards scar formation secondary corrective surgery might become necessary.

Traumatology

Zygomatic fracture of the left side that also includes the orbital floor
A computerized, virtual planning of the surgery is performed and patient specific titanium plates (arrows) for the reconstruction of the initial situation are fabricated
The patient specific titanium plates allow re-establishing a symmetric situation of the facial bones

Prof. Nkenke offers the full scope of treatment of trauma to the head and neck. Whenever necessary, surgery will be planned virtually and patient specific implants will be fabricated to secure the highest quality of fracture treatment. Depending on the severity of the trauma sometimes also secondary reconstructions might become necessary that can include scar correct, rhinoplasty or soft tissue augmentation.

Oral cancer surgery

Prof. Nkenke provides comprehensive treatment for oral cancer. Initially, based on clinical examinations and CT or MRI scans a treatment plan is developed and discussed with the patient. In complex cases the treatment will be interdisciplinary involving an oncologist and/or and radiotherapist. The aim of the surgery is to remove the tumor completely, while leaving function (e.g. speech, swallowing, chewing) untouched. In order to avoid spread of the tumor the surgical treatment almost always includes the removal of the lymphnodes of the neck (neck dissection). Bony or soft tissue defects will be reconstructed, immediately. This procedure might include free flap surgery. The surgery typically requires general anesthesia and the length of the inpatient stay can be variable.

Orbital surgery

The patient suffers from a left eye that is elevated and shows an exophthalmos
The patient suffers from a left eye that is elevated and shows an exophthalmos
A lesion within the orbit (arrow) causes the malposition of the eye (globe)
After the removal of the lesion the correct, symmetric position of the eyes is re-established
After the removal of the lesion the correct, symmetric position of the eyes is re-established

Prof. Nkenke offers the full scope of orbital surgery including orbital decompression and also performs upper and lower eye lid blepharoplasty. For cases of fractures of the orbital floor Prof. Nkenke recommends the use of individually planned, prefabricated, patient specific metal sheets for reconstruction.
The images of the patient case are taken from Nkenke et al. Untreated 'blow-in' fracture of the orbital floor causing a mucocele: report of an unusual late complication. .J Craniomaxillofac Surg. 2005;33:255-259.

Orthognathic surgery

Deviation of upper and lower jaw to the right
Skeletal situation before surgery
Virtual planning of the new jaw positions
Individual guides for the separation of the bone are fabricated
Individual plates for the fixation of the bone segments in the new position are fabricated
Symmetric alignment of the jaws

Prof. Nkenke is happy to offer the full scope orthognathic surgery which includes virtual surgical planning and simulation of the outcome of surgery. The fixation of the jaws in the new position can performed with prefabricated patient specific metal plates. The surgery is done typically under general anesthesia. The inpatient period at the hospital does last between one and 4 days depending on the complexity of the surgery.

Temporomandibular joint (TMJ) surgery

As a consequence of an accident the patient has developed a bilateral ankylosis of the TMJ (arrows)with the inability of opening the mouth.
The treatment approach is to open up the joint spaces in order to mobilize the lower jaw
Directly after the operation normal mouth opening is possible.
Condylar hyperplasia is characterized by an unilateral overgrowth of the condylar head (arrow)
The treatment requires the removal of the bony overgrowth (arrow)
The patient suffers from severe pain caused by an insufficient total joint replacement of the left TMJ
The artificial joint is removed and a distraction device is installed
The mandible is lengthened on the left side until a stable joint forms
In a final step the major part of the distraction device is removed
After the reconstruction of the left temporomandibular joint the patient did no longer suffer from pain during mouth opening

Prof. Nkenke is happy to offer the full scope of TMJ surgery. He performs the repair of TMJ fractures. He is also able to operate on TMJ ankylosis and to do total joint replacement. Prof. Nkenke also performs arthrocentesis and lavage arthroscopic surgery of the TMJ. Sometimes it will be necessary to treat locking or luxation of the joint by open surgery.

Wisdom teeth

The impacted wisdom tooth shows overlap with the inferior alveolar nerve (arrow) - Conventional complete removal is accompanied with an increased risk of damage to the nerve
In order to preserve the inferior alveolar nerve as a first step the clinical crown of the wisdom tooth is removed while the roots remain in place
After a few weeks the remaining part of the tooth erupts in a way that there is only minimal contact to the inferior alveolar nerve (arrow) - Complete removal of the tooth is possible now without the risk of nerve damage

Prof. Nkenke is happy to offer the full scope of TMJ surgery. He performs the repair of TMJ fractures. He is also able to operate on TMJ ankylosis and to do total joint replacement. Prof. Nkenke also performs arthrocentesis and lavage arthroscopic surgery of the TMJ. Sometimes it will be necessary to treat locking or luxation of the joint by open surgery.

PUBLICATIONS

Recent publications

Zimmermann M, Nkenke E. Approaches to the management of patients in oral and maxillofacial surgery during COVID-19 pandemic. J Craniomaxillofac Surg. 2020 Apr 4. pii: S1010-5182(20)30083-4. doi: 10.1016/j.jcms.2020.03.011. [Epub ahead of print] Review.

Moest T, Schlegel KA, Kesting M, Fenner M, Lutz R, Beck DM, Nkenke E, von Wilmowsky C. A new standardized critical size bone defect model in the pig forehead for comparative testing of bone regeneration materials. Clin Oral Investig. 2019 Aug 15. doi: 10.1007/s00784-019-03020-w. [Epub ahead of print]

von Wilmowsky C, Traxdorf M, Adler W, Neukam FW, Iro H, Nkenke E, Kesting M, Wurm M. Survival benefit for patients treated in a certified head and neck tumor center. Eur Rev Med Pharmacol Sci. 2019 Apr;23(7):2863-2869.

Baran CA, Agaimy A, Wehrhan F, Weber M, Hille V, Brunner K, Wickenhauser C, Siebolts U, Nkenke E, Kesting M, Ries J. MAGE-A expression in oral and laryngeal leukoplakia predicts malignant transformation. Mod Pathol. 2019 Jul;32(8):1068-1081.

Wagner F, Knipfer C, Holzinger D, Ploder O, Nkenke E.28 Webinars for continuing education in oral and maxillofacial surgery: The Austrian experience. J Craniomaxillofac Surg. 2019 Apr;47(4):537-541.

Ries J, Baran C, Wehrhan F, Weber M, Motel C, Kesting M, Nkenke E. The altered expression levels of miR-186, miR-494 and miR-3651 in OSCC tissue vary from those of the whole blood of OSCC patients. Cancer Biomark. 2019;24(1):19-30.

Knipfer C, Wagner F, Knipfer K, Millesi G, Acero J, Hueto JA, Nkenke E. Learners' acceptance of a webinar for continuing medical education. Int J Oral Maxillofac Surg. 2019 Jun;48(6):841-846.

Wurm MC, Hagen J, Nkenke E, Neukam FW, Schlittenbauer T. The fitting accuracy of pre-bend reconstruction plates and their impact on the temporomandibular joint. J Craniomaxillofac Surg. 2019 Jan;47(1):53-59.

Kerker FA, Adler W, Brunner K, Moest T, Wurm MC, Nkenke E, Neukam FW, von Wilmowsky C. Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin-a retrospective study. Clin Oral Investig. 2018 May;22(4):1625-1630.

Thiele OC, Kreppel M, Dunsche A, Eckardt AM, Ehrenfeld M, Fleiner B, Gaßling V, Gehrke G, Gerressen M, Gosau M, Gröbe A, Haßfeld S, Heiland M, Hoffmeister B, Hölzle F, Klein C, Krüger M, Kübler AC, Kübler NR, Kuttenberger JJ, Landes C, Lauer G, Martini M, Merholz ET, Mischkowski RA, Al-Nawas B, Nkenke E, Piesold JU, Pradel W, Rasse M, Rachwalski M, Reich RH, Rothamel D, Rustemeyer J, Scheer M, Schliephake H, Schmelzeisen R, Schramm A, Schupp W, Spitzer WJ, Stocker E, Stoll C, Terheyden H, Voigt A, Wagner W, Weingart D, Werkmeister R, Wiltfang J, Ziegler CM, Zöller JE. Current concepts in cleft care: A multicenter analysis. J Craniomaxillofac Surg. 2018 Apr;46(4):705-708.

Selected full text papers

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CONTACT

Private practice
Heimschollegasse 6-8
1130 Vienna
Austria

prof@nkenke.at
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