Abstract Aim Deep neck space abscesses (DNAs) are relatively common otolaryngology-head and neck surgery emergencies. We conducted the first and robust systematic review and meta-analysis to evaluate outcomes for ultrasonography-guided drainage (USD) versus conventional surgical incision and drainage (I&D). Method The protocol was published a priori (PROSPERO: CRD42023466809) and the study adhered to PRISMA guidelines. MEDLINE, EMBASE, Cochrane CENTRAL and key ENT journals were searched. Primary outcomes were length of hospital stay and recurrence. The secondary outcomes included scar formation/cosmetic, reported complications and cost savings. The quality of included studies was assessed using the Cochrane ROBINS-I and RoB2.0 tools. Fixed effects model was applied. Results Of 646 screened articles, seven studies enrolling 384 participants were included. USD was associated with a significantly shorter length of hospital stay (Mean Difference [MD] = -2.31, P < 0.00001), but no statistically significant difference was noted in the recurrence rate compared to I&D (odds ratio [OR] = 2.02, P = 0.21). USD appears to be associated with more cost-savings, better cosmetic outcomes, and fewer post-operative bleeding events. Conclusions USD appears to be associated with a shorter length of hospital stay, making it a viable and more cost-effective alternative. More randomized trials with adequate outcomes reporting are required to optimise the current evidence.