Clin Exp Otorhinolaryngol.  2023 Nov;16(4):317-325. 10.21053/ceo.2022.01634.

Endoscope-Assisted Hairline Approach for Head and Neck Masses: A Review

• Song MS
• Woo SH

• KMID: 2548360
• DOI: http://doi.org/10.21053/ceo.2022.01634

Abstract

Conventional surgery through a transcervical incision is indicated for the treatment of certain tumors in the head and neck. However, this method can cause multiple problems, including scarring and cosmetic concerns. The endoscope-assisted hairline approach, which serves as an alternative to conventional surgical procedures, is gaining popularity due to its excellent cosmetic and functional outcomes. However, given the anatomical complexity involved, the endoscope-assisted hairline technique is not frequently employed in head and neck surgery. The evolution of the hairline surgical approach has been influenced by changes in disease conditions and recent advances in surgical tools. This review article discusses the use of endoscope-assisted hairline approaches in the resection of head and neck masses, focusing on the surgical procedure and postoperative clinical outcomes.

Keyword

Head and Neck; Endoscope; Scar; Surgery; Hair Line Incision

Figure

• 

  Fig. 1. A 2×2-cm submandibular mass was excised using the hairline approach. (A) Markings were made preoperatively. (B) A 50-mm incision was made on the scalp, 1 cm behind the hairline. (C) The scalp flap was elevated to provide adequate height for the insertion of Sofield retractors into the surgical field.

• 

  Fig. 2. The hairline approach offers a cosmetic advantage by eliminating visible scars. (A) The surgical wound was positioned at the edge of the hairline. (B) Three months after surgery, the scar was concealed by the regrowth of hair. (C) A male patient 3 months after surgery. Even in patients with short hair, scars were seldom noticeable because they were situated along the hairline.

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  Fig. 3. An endoscopic view of submandibular gland (SMG) mass excision performed via a hairline incision. (A) The subplatysmal skin flap was elevated to establish an adequate working space. (B) Endoscopic guidance was utilized to identify any mass-like lesion. (C, D) Following meticulous dissection in the anterior and inferior direction, the SMG was identified. (E) The facial artery was easily identified with the aid of the endoscope and was preserved. (F) The SMG was subsequently excised and extracted through the surgical wound.

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  Fig. 4. A parotid mass was excised using the hairline approach. (A) The scalp flap was elevated following anterior dissection. (B, C) Anterior dissection was performed to reveal the sternocleidomastoid muscle and superficial parotid. (D, E) The parotid gland was surgically removed and extracted through the surgical wound.

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  Fig. 5. A neck mass was removed using the hairline approach. (A) An incision was created on the scalp, approximately 1 cm posterior to the hairline. (B) The scalp flap was elevated and extracted. (C, D) Meticulous dissection was performed, revealing the lesion. (E, F) The mass was subsequently excised and removed through the surgical wound. After histopathological examination, the mass was identified as a branchial cleft cyst.

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  Fig. 6. A cystic mass located in the lateral neck was excised. (A, B) An incision was made along the hairline, and the flap was elevated. (C, D) Endoscopic view of the surgical procedure. The mass was identified using a magnified view and clearly resected. (E) After tumor removal, the great auricular nerve (indicated by the arrow) was preserved. (F) At 1 week after surgery, the scar could be noted on the hairline and will not be visible after the hair grows.

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