Removal of pediatric branchial cleft cyst using a retroauricular hairline incision (RAHI) approach

Endoscope-assisted versus conventional second branchial cleft cyst resection

“…Thus, the operative field is clean and bloodless, and accidental injury or abrasion of surrounding structures can be avoided. In this present study, complications for both the endoscopeassisted group and conventional group were also in line with those observed after conventional surgery [13,14]. In the endoscope-assisted group, one case showed transient Fig.…”

“…This complication can be prevented by careful preservation of great auricular nerve overlying the sternocleidomastoid muscle. The incidence of damage to the great auricular nerve was not increased in our series compared with previous studies [13,14]. Sometimes, skin flap necrosis can develop, mainly along the angular margin of incision, but can usually be avoided by making a more obtuse angle and elevating a thicker cutaneous flap.…”

“…Another advantage of this method is that, during the operative procedure, the cysts are palpable and the operative instruments used in open surgery can also be used. Moreover, this randomized controlled study overcomes the limitation of the absence of a control group in previous studies [11,14]. Endoscopic technique provides good illumination and magnification of surgical procedures using a video monitor.…”

“…However, conventional open branchial cleft cyst resection usually requires a long incision line (more than 5.0 cm) on the neck, which is always opened, and sometimes leaves a prominent scar on the anterior neck [11], occasionally disturbing both patients and doctors. To overcome this obstacle, various approaches have been reported during the past decades, such as facelift approach [12], retroauricular approach [11,13,14], and endoscope-assisted neck approach [15,16]. These various approaches and methods have their own advantages and pitfalls, and which approach is the best choice for branchial cyst resection is still controversy.…”

“…In this method, the skin incision still leaves a visible scar, which is at the anterior border of the earlobe. To avoid this problem, Chen [11] and Roh [13,14] carried out second branchial cleft cyst resection via retroauricular approach, the postoperative scar of this approach being invisible because it is hidden by the auricle and natural hair; however, the narrower surgical view can be easily disturbed by poor illumination and smoke or fumes created by use of electrical cautery or the Harmonic scalpel. To overcome the poor operative field of view, Guerrissi [15] and Matsui [16] introduced the endoscope-assisted approach for branchial cleft cyst resection, but this procedure results in a scar 1.5-2.0 cm in length on the neck.…”