Occipital endoscopic approach: (Iaremenko (6))
An incision was performed in the occipital hairline region from occipital bone condylar fossa and going along the hairline 1.2 ± 0.3 cm under it. Layer by layer incision of skin and subcutaneous tissue was done. Fascia dissection was performed by means of unipolar and bipolar laparoscopic tools; a “tunnel” was formed under control of a rigid endoscope; “tunnel” vector was directed along the inferior border of the mandible. Anterior border of sternocleidomastoid muscle was visualized; fascia dissection under internal border of sternocleidomastoid muscle was performed, and the muscle was elevated by means of a retractor. Neurovascular bundle fascia was dissected and exposed the cyst fascia with an anterior-inferior adjoining swollen lymphatic node. In larger cysts, the cyst fascia exposed under the internal border of sternocleidomastoid muscle. In all the cases, aspiration of cyst fluid was performed. The fascia was clamped with forceps and excised by means of ultrasound unipolar and bipolar laparoscopic tools. Tube drainage was inserted into the wound on vacuum. The wound was closed layer by layer with biodegradable synthetic loop sutures. The skin incision was closed with polypropylene loop sutures. The wound was covered with tight aseptic dressing.
Appendix 3 : Studies using conventional surgery for removal of second branchial arch anomalies (including cysts, fistulas and sinus).