To report our preliminary experience with a retroauricular hairline incision (RAHI) for excision of second branchial cleft cysts (SBCC) and to present a relevant literature review.

Retrospective case series.

A retrospective chart review was conducted of two consecutive patients diagnosed with SBCC who underwent surgical removal via a RAHI. Relevant demographic, clinicopathological and radiological data were recorded. A web-based search was conducted to identify relevant scientific literature on “retroauricular hairline incision/approach” in order to present a systematic review of current literature.

In both cases, the SBCC (6.0 and 3.8 cm) could be safely excised without major complications. One patient developed a temporary hypoesthesia of earlobe. None of the patients had a postoperative infection, hematoma, spillage of cyst fluid or necrosis of the skin flap. All patients were satisfied with the cosmetic outcome of the procedure (100%). The incisions healed well without any evidence of hair loss or keloid formation.

In conclusion, the RAHI offers an excellent surgical outcome and superior cosmetic result with no proven increased risks to the patients who require surgical excision of a benign SBCC.