Endoscopic submandibular gland resection preserving great auricular nerve and periaural sensation

Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children

“…[ 28 , 35 ] Because most traction force during lifting of the skin flap is applied to the distal portion of the retractor, the tension on the GAN located at the proximal portion of the retractor is relatively minimal. [ 9 , 36 ] During the operations discussed in this report, the marginal mandibular branch of the facial nerve was usually left untouched because there was no mass spanning the submandibular area. Furthermore, a small wide flap elevation can preclude angular flap tip necrosis.…”

Feasibility of using the retroauricular approach without endoscopic or robotic assistance for excision of benign neck masses

“…3,5,7 Particularly in mass lesions at level II, such as a second branchial cleft cyst, excision via the retroauricular approach was very simply and easily performed under direct vision alone. In 22 of the 23 patients (95.7%) studied here, parotidectomy, submandibular gland resection, or excision of second branchial cleft cyst or lipoma involving levels II/III were successfully completed via a retroauricular approach, without using endoscopic or robotic assistance.…”

“…In addition, the operation time, drainage amount, hospital stay, and postoperative complications were comparable to those of previous studies using endoscopic and robotic systems, without compromising the cosmetic benefits acquired by using the retroauricular approach. 3,5,7 Particularly in mass lesions at level II, such as a second branchial cleft cyst, excision via the retroauricular approach was very simply and easily performed under direct vision alone. [10][11][12] Indeed, the anatomic location of a second branchial cleft cyst is consistent and characteristic (posterolateral to the submandibular gland, lateral to the carotid space, and anteromedial to the SCM muscle), which is easily accessible via the retroauricular approach, and the mass is well encapsulated, allowing easy capsular dissection.…”

“…6 In addition, because the submandibular gland resection via the retroauricular approach starts from the posterior side of the submandibular gland, in contrast to the conventional approach, which is performed at the lateral side of the submandibular gland, adequate exposure of the posterior portion of the submandibular gland is extremely important. 3 Therefore, the retroauricular approach may be challenging in large submandibular gland tumors located in the posterior portion of the gland, because the tumor may obstruct the surgical view and dissection path, and preclude to clamping of the posterior part of the gland, which is necessary for the appropriate traction of the gland. The only case in which we failed to complete surgery under direct vision and required endoscopic assistance was for a 4.5 cm submandibular gland tumor located in the posterior portion of the gland.…”

“…To minimize this cosmetic issue, a retroauricular approach has been proposed for removal of benign upper neck masses, and has shown better cosmetic outcomes than the conventional skin incision by hiding the scar behind the auricle and hair. [1][2][3][4][5][6][7][8] In most studies using the retroauricular approach, surgery via retroauricular incision has been performed using an endoscopic or robotic system for parotid gland tumors, submandibular gland tumors, second branchial cleft cysts, and lymph nodes or soft tissue tumors of the level II/III region. 2,4,5,7,9 On the basis of these recent studies, the use of endoscopic and robotic systems for the retroauricular approach has spread widely, even in removal of simple benign masses for aesthetic purposes.…”