Retroauricular Hairline Incision Research Articles

Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision.

Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC. The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient. Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66months. The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC. 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 .

Single incision-plus approach for gasless endoscopic parotidectomy: a seven-step procedure.

Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.

Intracapsular enucleation of cervical schwannomas via retroauricular hairline incision

IntroductionCervical schwannomas are rare diseases treated by complete resection, leading to potential neurological deficits. Intracapsular enucleation is an acceptable alternative to preserve the involved nerve function, but the clinical outcomes by an aesthetically pleasing approach remain unrevealed. This study evaluated functional and oncological outcomes after intracapsular enucleation of cervical schwannomas via retroauricular hairline (Roh's) incision. Materials and methodsThis prospective observational study included 17 patients with cervical schwannomas who underwent intracapsular enucleation to preserve the involved nerve and capsule via Roh's incision. Each patient was evaluated with any complications, nerve function, subjective satisfaction, voice and swallowing questionnaires, and local recurrence. ResultsIntracapsular enucleation via the Roh's incision was successfully applied to all patients for a median operation time of 48 min. Tumours of 4.5-cm median size were removed with the minimization of injury to the nerve and sheath deflected on the surface of the tumour. Temporary and permanent paralysis of the unilateral vocal fold was found in 3 (33%) and none of 9 patients with vagal schwannomas, respectively. Horner's syndrome occurred temporarily in two of 5 (40%) patients with sympathetic chain schwannomas. Postoperative complications were minor. Subjective satisfaction of scar and facial deformity was high, and subjective voice and swallowing difficulties were minimal one year after surgery. No recurrence was found in the patients for a median follow-up of 82 months. ConclusionIntracapsular enucleation via Roh's incision is a viable treatment for cervical schwannomas with the highest functional, cosmetic, and oncological outcomes.

Selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for deep lobe parotid pleomorphic adenoma.

Deep lobe parotid tumour is commonly removed with the covering superficial lobe of parotid gland. Total or subtotal parotidectomy leads to an increase in surgical morbidity. This study evaluated recurrence and function after selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for pleomorphic adenoma. Twenty-eight patients with deep lobe parotid pleomorphic adenomas underwent selective deep lobe parotidectomy with preservation of the superficial lobe and the facial lobe via Roh's incision. Each patient was evaluated with any complications, cosmetic and salivary functions and local recurrence. Superficial lobe-preserving surgery via Roh's incision was successfully applied to all patients without injury to the facial nerve and the Stensen's duct for a median operation time of 65min. Facial nerve paralysis was found only temporarily in 9 (32%) patients, and other complications were minimal. None of the patients had postoperative Frey's syndrome. Salivary secretory function in the operated side was well preserved. No recurrence was found in the patients for a median follow-up of 94months. Selective deep lobe parotidectomy via Roh's incision is a reliable option of treatment for deep lobe parotid pleomorphic adenoma.

Application of supraomohyoid neck dissection via retroauricular hairline incision in patients with oral cancer

ObjectiveTo explore the application of supraomohyoid neck dissection via retroauricular hairline incision in patients with oral cancer, thereby providing a basis for the surgical treatment of patients with oral cancer in clinical practice. MethodsA total of 68 patients with oral cancer who met the inclusion criteria and exclusion criteria were included in our hospital from August 2018 to June 2020. According to the random number table method, they were divided into the experimental group (34 cases), in which patients underwent supraomohyoid neck dissection via retroauricular hairline incision, and control group (34 cases), in which patients received neck dissection. ResultsThe operation time was significantly longer and the intraoperative bleeding was significantly less in the experimental group compared with those in the control group (both P < 0.05). No significant differences in postoperative drainage, number of detected lymph nodes and length of hospital stay were detected between the two groups. One month after surgery, the scores of pains, muscle strength, range of motion and daily activities were significantly higher in the experimental group than those in the control group (all P < 0.05). Three months after surgery, the scores of pains, muscle strength, range of motion and daily activities were higher compared with those at one month after surgery in both groups, and these scores in the experimental group were higher than those in the control group (all P < 0.05). In addition, the scores of shoulder function, language, deglutition, chew, work, entertainment, activity of daily living, facial features, pain and degree of satisfaction to the scars in the experimental group were significantly higher than those in the control group one month after surgery (all P < 0.05). ConclusionSupraomohyoid neck dissection via retroauricular hairline incision can reduce the amount of intraoperative bleeding in patients with oral cancer, is beneficial to the recovery of shoulder joint function, improves the patient's quality of life and the degree of satisfaction to the scars, reduces the occurrence of related complications. It has relatively high safety and is worthy of clinical application and promotion.

Application analysis of a modified retroauricular hairline incision in the resection of a benign parotid gland tumor.

This study aimed to evaluate the application value of a modified retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle in the resection of benign parotid gland tumors. Forty-eight patients with benign parotid gland tumors were retrospectively analyzed: 19 cases were included in the experimental group with an improved retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle, and 29 cases were assigned in the control group with a modified facelift incision. Operation time, postoperative drainage, postoperative esthetic degree, and incidence of facial nerve paralysis, salivary fistula, and Frey's syndrome were compared. After the esthetic procedure, the average score of the experimental group was higher than that of the control group, and the esthetic effect of the former was better than that of the latter (P<0.05). The incidence of the operation time, facial nerve paralysis, salivary fistula, and Frey's syndrome of both groups had no statistically significant differences (P>0.05). The modified retroauricular hairline incision and sternocleidomastoid flap with an inferior pedicle can be applied to resect benign parotid gland tumors safely. It shows a better cosmetic effect and does not cause obvious postoperative complications. Therefore, it should be promoted for tumor treatments.

Robotic Surgery in Head and Neck in Pediatric Population: Our Experience.

Robot assisted surgery of the head and neck is a relatively novel approach in the management of head and neck tumors. There are very few reported cases of robot-assisted surgery of the head and neck in pediatric population in the world literature and no report of such procedures in the Indian subcontinent. In this article we present three such cases we performed for the first time in the country. The first case is that of second branchial cleft cyst, the second is a 4-year-old boy with a tongue base cyst and the third patient is a 12-year-old girl with left parotid gland tumor. All the patients underwent successful Robotic surgeries. Case 1 underwent robotic excision of the cyst through a retroauricular hairline incision. Case 2 underwent transoral robotic excision of the tongue base cyst. Case 3 underwent robotic excision of the tumor through a modified facelift incision. The mean docking time for the robot was 12.33min and approximate blood loss was less than 10ml in all cases. The patient and their parents were extremely satisfied with the cosmetic outcomes of the scarless surgery. Robot assisted surgery has the advantage of performing minimally invasive procedures within constrained spaces especially in children. The multiarticulated endowrist movements of the robotic arms combined with higher magnification and three-dimensional depth perception allows a precise surgery with better visualization in otherwise inaccessible areas resulting in better surgical outcome. With exceptional advantages of scarless surgery, minimal blood loss and postoperative pain and better surgeon ergonomics, robotic technique is an effective and feasible option in Pediatric Head and neck Surgery.

ROBOTICS IN ENT HEAD AND NECK SURGERY

Robot assisted surgery in the specialty of ENT Head and Neck Surgery can be classified into Transoral Robotic Surgery (TORS) for lesions in the oropharynx, larynx, hypopharynx and Remote access surgery through a hidden Retro Auricular Hairline Incision (RAHI) for removal of neck masses without leaving a scar in the visible portion of the neck. TORS has the advantages of excellent three-dimensional visualization, magnification in all directions, accessibility to the otherwise blind areas in the upper aero digestive tract. TORS offers significant benefits and lower morbidity rates as compared to the conventional surgical procedures and other adjunctive treatments like chemoradiation in selected patients. The indications of robotic surgery are expanding with the introduction of the retroauricular approach for various neck lesions which includes thyroidectomy, removal of tumors from parathyroid glands, parapharyngeal space, submandibular gland, branchial cleft cyst and neck dissection for metastatic cervical lymphadenopathy. This approach will become popular with young patients who want better cosmesis. With the latest innovative developments in the technology and design of surgical robots, robotic surgery will continue to occupy an increasingly important role in the specialty of ENT-Head and neck surgery. In the future, we will see the widespread application of robotics not only for TORS or Retroauricular approach neck surgeries but also in Otology, Skull base and Paediatric Otolaryngology. Keywords: Robot assisted surgery, Transoral Robotic Surgery (TORS), Remote access surgery.

Robotic-assisted supraomohyoid neck dissection via retroauricular hairline incision

Objective: To explore the feasibility of using da Vinci Surgical System to perform supraomohyoid neck dissection (SOND) to avoid visible scar and reduce trauma. Methods: Between September 2017 and December 2018, twenty patients (two females and 18 males, mean age, 54.8 years) with oral cancer treated in the Department of Stomatology, Hainan Hospital of General Hospital of Chinese PLA were enrolled in this study. Eight patients were assigned into robotic surgery group, and received robot-assisted SOND with retroauricular hairline incision. After the da Vinci Surgical System robotic platform was positioned, the neck dissection was performed in level Ⅱb, Ⅱa, Ⅲ, Ⅰb and Ⅰa orderly from the near region to far region. The other 12 patients were assigned into traditional surgery group, and received SOND with a traditional incision. The operation time, bleeding and amount of lymph node dissected were compared between two groups. Results: All the 8 cases of robot-assisted SOND were completed smoothly. Operation time [(4.5±1.0) h] was significantly longer in robotic surgery group than that [(2.5±1.0) h] in traditional surgery group (P<0.05). The amount of bleeding in robotic surgery group [30.0 (27.5) ml] was significantly lower than that in traditional surgery group [(100.0 (87.5) ml, P<0.05]. There's no difference in the number of lymph nodes dissected between robotic surgery group (23.6±5.2) and traditional surgery group (22.8±6.0)(P>0.05). No postoperative hemorrhage, symptoms of nerve injury, flap necrosis and secondary healing were observed in robotic surgery group. Conclusions: SOND through retroauricular hairline incision is feasible with the assistance of da Vinci Surgical System. The main advantage of this method is superior esthetic effects due to a hidden incision with minimal bleeding. There was no obvious differences in the amount of lymph nodes dissected and postoperative complications between two methods. However, robotic surgery costs a significantly longer operation time than traditional neck dissection.

Retroauricular hairline incision を用いた耳下腺良性腫瘍手術

An S-shaped incision is most frequently used for surgeries on benign parotid gland tumors. Surgical procedures using a retroauricular hairline incision (RAHI) for parotid gland tumors was first reported in 2009, but no such case has been reported from Japan. Because RAHI leaves no trace of visible scarring in the face and neck, it is more favorable in terms of cosmetics than an S-shaped incision. We operated on 25 cases of benign parotid gland tumors using RAHI between February 2012 and June 2014. In this report, we give a detailed description of the RAHI procedure, and quantify and compare operative time, bleeding, and complication rate between RAHI procedure and conventional methods. The mean operative time was 150.2 min. Permanent facial paralysis was observed any RAHI case. However, transient facial paralysis was seen in 20.0% RAHI cases, and this value is similar to data reported previously. Because RAHI does not require a preauricular skin incision, unlike S-shaped and facelift incisions, it is difficult to gain an anterosuperior view of the parotid gland. In other words, tumors in the lower pole of the superficial lobe of the parotid gland are the best indication for RAHI. RAHI is a useful approach when performed by surgeons with sufficient experience with standard methods and when surgical indications are accurately determined.

Partial Superficial Parotidectomy via Retroauricular Hairline Incision.

ObjectivesThe purpose of this study was to evaluate the usefulness of retroauricular hair line incision (RAHI) in partial superficial parotidectomy by comparison with modified Blair incision or facelift incision.MethodsMedical records of 73 patients with benign parotid tumor who underwent partial superficial parotidectomy were retrospectively reviewed. Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey's syndrome, and cosmetic outcomes were compared among RAHI, facelift incision (FLI), modified Blair incision (MBI) groups.ResultsRAHI group showed better cosmetic results than FLI group or MBI group compared with other type of incisions (P<0.001, P<0.001, respectively). Among the 3 groups, there were no significant differences of operative time and location of tumor (P=0.377), size of tumor (P>0.999), occurrence of temporary or permanent facial nerve paralysis (P=0.745) and Frey's syndrome (P=0.940).ConclusionPartial superficial parotidectomy can be done safely by RAHI in most cases of benign parotid tumor. Compared with MBI or FLI, RAHI has better cosmetic outcome with no increase of operative time or postoperative complications.

Branchial Fistulas—A Rare Entity in Pediatric Otorhinolaryngology: Current Management Protocols and Review of Literature

ABSTRACTBackground/objectivesSurgical managements which form the mainstay of these branchial apparatus anomalies are based on accurate understanding of the embryology and surgical anatomy. The conspicuous scarring in the young which becomes conspicuous as the age advances are reduced by newer approaches, the facelift approach, retroauricular approach and endoscope-assisted neck approach.Case reportA retrospective case series analysis of eight patients with complete fistula managed by the combined trans cervical approach. The recurrence was nil, with good surgical access and minimal scar at the incision site.ConclusionCombined transcervical approach is the conventional procedure of choice for branchial fistulas. While retroauricular hairline incision (RAHI) approach and endo-scopic approaches need expertise and more instrumentation, meticulous cosmetic surgery techniques helps reduces scars of the transcervical approach.How to cite this articleBhat RS, Naik SM, Goutham MK, Bhat S, Appaji M, Chidananda KV, Devi NP, Joseph S, Nayak P. Branchial Fistulas—A Rare Entity in Pediatric Otorhinolaryngology: Current Management Protocols and Review of Literature. Int J Head Neck Surg 2014;5(3):108-111.

Primum non nocere, deinde philosophare

We read with interest the article entitled Retroauricular Video-Assisted ‘‘Gasless’’ Thyroidectomy: Feasibility Study in Human Cadavers [1]. This article describes a new ‘‘distant access’’ minimally invasive surgical approach to the thyroid gland. The article presents for the first time the retroauricular hairline incision approach to the thyroid gland using the endoscopic assistance gasless technique. The proposed technique allowed hemithyroidectomy to be performed through an 11.8 ± 1.2-cm incision [2] in six human cadavers. In our opinion, the surgical technique described by the authors is limited to hemithyroidectomy. Total thyroidectomy could be performed through a bilateral retroauricular access. We think the 11.8 ± 1.2-cm incision is quite large for a video-assisted approach to the thyroid gland and that a double-size incision due to the bilateral approach is not justified for a total thyroidectomy. This extensive access is not justified for either minimally invasive surgery or open surgery. Kocher’s cervicotomy, video-assisted thyroidectomy (VAT), and minimally invasive video-assisted thyroidectomy (MIVAT) remain the best options for thyroidectomy or parathyroidectomy. A surgical access far from the targeted organ can increase the risk of infection and can damage important structures not identified in reaching the thyroid gland. The described procedures entail an increased risk of damage to the great auricular nerve, lesser occipital nerve, facial nerve, accessory nerve, hypoglossal nerve, digastrics muscle, styloyoid muscle, internal jugular vein, external carotid artery, phrenic nerve, and vagus nerve. The risk of infection also is increased due to the proximity of the incision to less clean areas of the body (ear and hair). Because of the high increased risks added with this procedure, we think the most important thing in surgery is primum non nocere, deinde philosophare (do not harm first, philosophize later). The authors mention that the end point of the study was to achieve gland resection with identification and preservation of the recurrent laryngeal nerve. Because the study was conducted with human cadavers, preservation of the nerve could not be identified with certainty. The authors have recorded 100% success in a cold, bloodless setting, but we know that every time the camera is moved, the risk of causing damage to important anatomic structures is increased [3], especially with the gasless technique. The authors mention two added complications: dysthesia of the earlobe and alopecia at the incision site. These complications preclude the good cosmetic results they mention as an end point desired by the patient. To achieve good cosmetic results, plastic surgery after a classic Kocher’s cervicotomy would be more appropriate. In fact, the authors have written that ‘‘overall patient satisfaction with the resultant scar on a visual analogue scale was significantly higher in patients in the retroauricular cohort as compared with patients having a traditional cervical incision’’ [2]. This underscores the importance of the cosmetic result for the patient, but the citation is incorrect because in the mentioned study, the authors compare a lateral neck upper incision with retroauricular access. Therefore, it is not possible to know whether the patient prefers a classic G. Galata (&) M. Mulla Department of Surgery, King’s College Hospital, NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK e-mail: g.galata@libero.it

Retroauricular Hairline Approach for Excision of Second Branchial Cleft Cysts

ABSTRACTObjectiveTo report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review.Study designRetrospective case series.MethodsA retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological and radiological data were recorded. A web-based search was conducted to identify relevant scientific literature on “retroauricular hairline incision/approach” in order to present a systematic review of current literature.ResultsIn both cases, the SBCC (6.0 and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of earlobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation.ConclusionIn conclusion, the RAHI offers an excellent surgical outcome and superior cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.

Retroauricular hairline approach for excision of second branchial cleft cysts: A preliminary experience

To report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review. Retrospective case series. A retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological, and radiological data was recorded. A web-based search was conducted to identify relevant scientific literature on "retroauricular hairline incision /approach" in order to present a systematic review of current literature. In both cases, the SBCC (6.0 cm and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of ear lobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid, or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation. In conclusion, the RAHI offers an excellent surgical outcome and cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.

Extracapsular dissection of benign parotid tumors using a retroauricular hairline incision approach

Extracapsular dissection has emerged as a more conservative approach to parotid surgery. The parotid surgery commonly begins with a modified Blair or facelift incision. Although minor, the incision scar from these incisions is visible on the face and neck. I initially developed a retroauricular hairline incision (RAHI) for the removal of benign lesions in the upper neck with a more esthetic look. The RAHI approach also may be used for selected patients with benign parotid neoplasms. Mobile benign tumors arising in the inferior superficial part of the parotid gland may be removed by the RAHI approach without compromising surgical visualization. This surgery appears to show excellent cosmetic outcomes in addition to the benefits of extracapsular dissection, lower complication rates, and preservation of secretory function. The RAHI without a preauricular incision is a feasible technique in the surgical management of parotid tumors.

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

Branchial cleft cyst (BCC) is treated surgically using a transcervical approach, leaving potential cervical scars. This prospective study assessed the outcomes of retroauricular hairline incision (RAHI) approach for BCC excision in children. Twelve patients with second BCC (age < 18 years) underwent cyst excision via the RAHI approach, with incision along the postauricular sulcus and hairline. The operation time, complications, and subjective satisfaction with incision scars were assessed. Mean operation time was 45 +/- 12 min. There were no significant complications, except for temporary hypoesthesia of the earlobe. Hypertrophic scars at incision sites occurred in two patients, but these scars are usually hidden by the natural hair and auricle. Mean subjective satisfaction score regarding incision scars was 8.7 +/- 0.9 out of 10. The RAHI approach may provide good aesthetic results without significant surgical morbidities. This may be an alternative option for the surgical excision of BCC for children and their parents who desire invisible external scars after surgery.

The retroauricular hairline incision (RAHI) approach for head and neck surgery

Incisions in head and neck surgery are usually made along natural skin creases or esthetic units of the face and neck. Retroauricular hairline incisions have been reported to have cosmetic benefits for the removal of upper neck masses. Incisions were made along the postauricular sulcus and inside the hairline, and masses were removed after subcutaneous tunneling. This approach can be used for excision of most benign masses of the upper neck and for biopsy of malignant lesions. This postauricular approach, using a potentially invisible area, has clear cosmetic benefits compared with conventional cervical incisions. This approach will be helpful for patients with surgically indicated upper neck masses who would like to have invisible incision scars.

Retroauricular Hairline Incision for Removal of Upper Neck Masses

The general population has been increasingly concerned about cosmesis and hopeless about prominent or invisible postoperative scars of the face and neck. The purpose of this study was to evaluate the benefit of a retroauricular hairline incision (RAHI) by comparing it with conventional cervical incision for removal of upper neck masses. Prospective clinical study. Thirty-four patients with upper neck masses were divided into two surgical groups of RAHI (17) and conventional cervical incision (17) matched by age, sex, marital status and size, location, pathology of lesions. The operation time, complications, length of hospital stay, and subjective satisfaction with incision scar checked by visual analogue scale were compared between groups. The lesions of each group were congenital cysts (6), abscesses (2), inflammatory masses (2), and benign (6) or malignant (1) tumors and located in the upper neck. Mean operation time was 51 +/- 17 minute in the RAHI group and 41 +/- 13 minutes in the controls (P = .064). Mean hospital stay and complication rates were comparable between groups. Mean score of patient's satisfaction was 8.9 +/- 0.7 in the RAHI group and 4.5 +/- 2.7 in the controls (P < .001). The degree of incision scarring did not differ between groups, but the scars were less visible in the RAHI group because of hiding by the auricle and hair. The postauricular approach leading to a potentially invisible area of operation has a clear cosmetic benefit compared with conventional cervical incision. This will be helpful for patients with surgically indicated upper neck masses who hope for invisible incision scars.