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Endoscopic ear, sinus and skull base surgery working group.

Grupo especializado en cirugía endoscópica de oído y senos paranasales, organización de cursos de disección en Barcelona.

19/10/2026

Bonus Track: Combined Endoscopic and Microscopic Approach for Complex Cholesteatoma Surgery 🎧👨‍⚕️

In this case, pre-op CT scans revealed a cholesteatoma extending from the tympanic cavity down to the mastoid antrum. To achieve complete clearance while minimizing morbidity, we performed a combined approach:

Endoscopic Phase: Transcanal elevation of a wide tympanomeatal flap, precise dissection of the cholesteatoma from the facial nerve niche and mesotympanum, and initial attic drilling.

Microscopic Phase: Cortical mastoidectomy with a pedicled periosteal flap, followed by combined endoscopic dissection through the antrum to safely clear hidden areas in the anterior epitympanum.

Reconstruction: Mastoid obliteration, ossiculoplasty using a PORP, and tympanic membrane reconstruction with cartilage palisades.

Full surgical video: https://youtu.be/37o4t9Wtwjw

16/10/2026

Immediate operating room result for male septorhinoplasty. Structural support restored to improve both airway function and profile definition while preserving natural masculine features.

13/10/2026

🩺 Unilateral Maxilloethmoidal Chronic Rhinosinusitis on Coronal CT!

Take a quick look at this coronal CT scan demonstrating clear mucosal thickening and opacification affecting the right maxillary and ethmoid sinuses, commonly linked to osteomeatal complex obstruction.

Key imaging findings in chronic rhinosinusitis (CRS) help guide surgical planning and medical management.

What’s your go-to approach when evaluating sinus anatomy on CT? Let me know in the comments! 👇

05/10/2026

Right Full House Endoscopic Sinus Surgery (FESS) in a patient with co**ha bullosa and diffuse chronic rhinosinusitis without polyps.

Key Surgical Steps:

Concha Bullosa Management: Resection of the lateral segment using electrocautery and turbinate scissors to establish adequate working space in the middle meatus.

Uncinate Process & Maxillary Antrostomy: Initial uncinectomy with a backbiter, followed by microdebrider mucosal reduction to minimize bleeding and maintain clear visual fields.

Intact Bulla Technique: Preserving the ethmoid bulla as a safe posterior anatomical landmark to navigate into the frontal recess, achieving a Draf IIa frontal sinusotomy without drilling.

Posterior Ethmoidectomy & Sphenoidotomy: Dissecting the ethmoid bulla and basal lamella to localize the natural sphenoid ostium, bringing all sinus outflow tracts into a single line of sight.

Precise mucosal preservation and strict adherence to surgical landmarks remain paramount for safe, efficient sinus clearance.

28/09/2026

Immediate post-op of a primary septorhinoplasty.

Beyond structural profile alignment, the primary surgical objective for this patient with Obstructive Sleep Apnea (OSA) was reducing internal nasal resistance to optimize CPAP adaptation and compliance.

Form and function aligned.

24/09/2026

🔍 Case of the day: Right Sphenoid Aspergilloma 🧠

This axial CT scan demonstrates dense opacification within the right sphenoid sinus, characteristic of a fungal ball (mycetoma).

Sphenoid sinus lesions can present with vague symptoms such as chronic retro-orbital headache, making cross-sectional imaging key for accurate diagnosis and surgical management.

Have you encountered a sphenoid sinus fungal ball recently? Let us know in the comments! 👇

22/09/2026

Intraoperative perspective: precise dissection and clear anatomical visualization are essential for safe, predictable surgical outcomes.
Key principles in this approach:

• Systematic identification of key surgical landmarks.

• Meticulous hemostasis to maintain an optimal visual field.

• Preservation of functional tissue with minimal surgical trauma.

How do you approach this specific step in your surgical workflow?

Full video on my YouTube channel!

17/09/2026

Post-traumatic laterorhina correction.
This overhead perspective highlights the restoration of the nasal axis following trauma. Correcting a severely deviated nose requires a combination of structural septal reconstruction and targeted osteotomies to re-establish midline symmetry and restore full airway function.

14/09/2026

No two sinus surgeries are identical. Preoperative anatomical variations can significantly reshape the surgical field, transforming a standard dissection into a high-precision maneuver.

This coronal CT scan illustrates how subtle anatomical nuances redefine the risk profile during Endoscopic Sinus Surgery (FESS):

Haller cells (infraorbital ethmoid cells): Situated along the orbital floor, these cells significantly narrow the maxillary infundibulum and displaced the natural ostium. Their presence reduces the working space and increases the risk of orbital entry or incomplete drainage if not carefully identified.

Ethmoidal calcifications / hyperdense concretions: High-density intra-ethmoidal material requires precise instrumentation and tactile feedback, particularly when clearing disease near delicate landmarks like the lamina papyracea and anterior skull base.

Comprehensive CT mapping remains critical for tailoring the surgical approach, ensuring complete clearance while preserving surrounding structures.

07/09/2026

Step-by-step Full Endoscopic Sinus Surgery (FESS) for bilateral chronic sinusitis 🩺✨
In this case, even without nasal polyps, a complete dissection of the sinuses is essential to restore proper drainage and ensure intranasal corticosteroid sprays can reach the areas they need to!

Key surgical steps in this breakdown:
1️⃣ Uncinate Process: Opening the unciform (the first gateway) and expanding the antrostomy.

2️⃣ Frontal Recess: Locating and opening the frontal recess anterior to the ethmoid bulla while protecting the skull base.

3️⃣ Ethmoidectomy & Debridement: Opening the ethmoid bulla and using a microdebrider to clear bone fragments and mucosa efficiently with minimal bleeding.

4️⃣ Sphenoid & Maxillary Exposure: Gaining clear visibility and access across all sinus cavities.

Using landmarks correctly keeps perspective sharp throughout the entire procedure! 🧠💡
What’s your go-to sequence when approaching the frontal recess? Let me know in the comments! 👇

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Barcelona
08907

Página web

http://www.doctorbartel.com/, https://youtube.com/@drricardobartel?si=ia8pp1NlYfs8DFj5

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