Comparison of Visor Access Approach with Lower LIP Split Approach in Resection of Oral Cancers

• Published in: Indian journal of otolaryngology, and head, and neck surgery and head, and neck surgery, 2023-06, Vol.75 (2), p.299-305
• Main Authors: Vyshnavi, V., Azeem Mohiyuddin, S. M., Mohammadi, Kouser
• Format: Article
• Language: English
• Subjects: Cancer; Fistula; Head and Neck Surgery; Medicine; Medicine & Public Health; Oral cancer; Original Article; Otorhinolaryngology; Squamous cell carcinoma; Surgical outcomes
• ISSN: 2231-3796; 0973-7707
• DOI: 10.1007/s12070-022-03166-2

Purpose There is high prevalance of oral cancers particularly buccal mucosa and lower gingivobuccal sulcus in our region. These can be approached by both Lower lip split and by Visor approach. Anteriorly placed oral cancers can be resected by visor approach, retaining oral competence and lower lip vascularity. Visor approach is challenging in locally advanced oral cancers requiring reconstruction. We compared outcome of resection of lateralized oral cancers by lower lip split approach and visor approach with regard to duration of surgery, adequacy of exposure of tumour, access for reconstruction, resection margins and complications. Methodology 66 Patients with T2 & T3 staged oral squamous cancers were randomized into two groups. Following neck dissection, Group A underwent composite resection by lower lip split, and Group B by visor approach. Variables mentioned above were compared between two groups. Results This study included patients with T2(58%)and T3 (42%) oral cancers. Except 3 patients in Group B, adequacy of exposure was similar in both groups. Operating time was longer in Group B. Close margins anteriorly were more frequent in Group A. Axial flaps(98.5% ) and radial forearm free flaps(1.5%) were used for reconstruction. Suturing bulky flaps was difficult in Group B( 9.1%).Most common complication in both groups was orocutaneous fistula. Conclusion Adequacy of exposure, resected margins, surgical outcome with regards to healing and complications were similar between lower lip split and visor approach in oral cancers. Visor approach for resection of oral cancers is preferred option in tumours close to oral commissure. Summary Oral cancers particularly buccal mucosa and lower gingivobuccal sulcus in our region and these can be approached by both Lower lip split and by Visor approach. Adequacy of exposure, resected margins, surgical outcome with regards to healing were similar in lower lip split and visor approach. Complications were also similar between lower lip split and visor approach in oral cancers. Visor approach for resection of oral cancers is preferred option in tumors close to oral commissure. Most common complication in both groups was orocutaneous fistula.