title: Comparison of the Retroauricular Approach and Transcervical Approach for Excision of a Second Brachial Cleft Cyst.
abstract: OBJECTIVE
  Although a retroauricular (RA) approach has been proposed for excision of a second brachial cleft cyst (BCC), no studies have performed a direct comparison of the results of the RA approach and those of the conventional transcervical approach. We evaluated the surgical outcomes of the RA approach under direct vision and demonstrate its benefits compared with the conventional transcervical approach for excision of a second BCC.
  
  
  METHODS
  From January 2012 to May 2016, we enrolled 30 consecutive patients with a second BCC who underwent surgical excision as a primary treatment into the present prospective case-control study. Of the 30 patients, 13 underwent excision of a second BCC with the RA approach and 17 with the conventional transcervical approach. The surgical results, complications, and subjective scar satisfaction scores were estimated and compared between the 2 groups.
  
  
  RESULTS
  In all 30 patients, excision of the second BCC was successfully completed under direct vision using the RA or conventional transcervical approach. The mean operating time was significantly less in the conventional group than that in the RA group (68.4 vs 83.4 minutes, respectively; P = .019). No differences were found in the total drainage amount, drainage duration, duration of hospital stay, or postoperative complications between the 2 groups. The mean scar satisfaction score was 6.2 in the conventional group and 8.8 in the RA group, and this difference was statistically significant (P < .001).
  
  
  CONCLUSIONS
  The RA approach under direct vision for excision of a second BCC is feasible and results in better cosmetic outcomes than the conventional transcervical approach, with no increase in surgical morbidity.
authors.affiliation: Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Jung-Gu, Daegu, Korea.
authors.forename: Dongbin
authors.initials: D
authors.lastname: Ahn
authors.affiliation: Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Jung-Gu, Daegu, Korea.
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Lee
authors.affiliation: Professor and Department Head, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Jung-Gu, Daegu, Korea. Electronic address: entgodlikeu@gmail.com.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Sohn
mesh_terms: D000293:Adolescent; D000328:Adult; D001935:Branchioma / Q000601:surgery*; D016022:Case-Control Studies; D004954:Esthetics; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D061646:Operative Time; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome