INTRODUCTION
Second branchial cysts (SBCs) are the most common second branchial arch
anomalies (SBAAs) in adults whereas sinuses, fistulas and cartilaginous
remnants are in children (1–3). The branchial arches consist of clefts
and pouches and are the embryological precursors of the face, neck and
pharynx. In total, six pairs of branchial arches form on either side of
the pharyngeal foregut. Incomplete obliteration of these arches can lead
to formation of branchial anomalies, of which the SBAA represent up to
95% of the cases (2). The second branchial arch forms part of the hyoid
and surrounding structures of the head and neck, while the second
branchial pouch shapes the palatine tonsil and the supratonsillair fossa
(1). Therefore SBAAs can occur anywhere along the course of the second
branchial arch tract that extends from the skin overlying the
supraclavicular fossa up to the pharynx at the level of the tonsillar
fossa (2).
In adults, when encountering an unilateral swelling of the neck, a
cystic metastasis of head and neck cancer should always be excluded
before SBC diagnosis can be confirmed (4,5). Since SBCs are prone to
recurrent infections and do not dissolve spontaneously, early and
complete surgical excision is the recommended treatment (1,6). Different
surgical techniques for SBC removal have been proposed. Traditionally,
conventional surgery using a large cervical incision was used to ensure
complete removal (7). However, the large cervical incision results in a
prominent scar. In an attempt to reduce visible scars, newer techniques
have been developed, such as endoscopic surgery (6,8–10) and the use of
a retro-auricular hairline incision (RAHI) (11–13). RAHI can be
performed either as an open procedure using a ‘facelift’ incision or as
an endoscopic technique. To provide insight in the optimal surgical
management of patients presenting with a SBC, this systematic review
evaluates which surgical technique (conventional, endoscopic or RAHI)
for SBC removal results in the lowest recurrence and complication rates
with the highest scar satisfaction.