Purpose <p>Surgical resection of oral cancers requires meticulous planning to achieve clear margins and minimize potential morbidity. This study aimed to compare postoperative surgical and functional outcomes following central and lateral lip-split approaches used for resection and reconstruction of oral tumours.</p> Methods <p>A retrospective review of 79 cases involving lip-split procedures for head and neck cancers was conducted. Data were collected from a prospectively recorded database (December 2015 to December 2022). Statistical analyses compared patient demographics, intraoperative characteristics, and postoperative outcomes between central and lateral lip-split cohorts.</p> Results <p>Lateral lip splits were associated with higher rates of postoperative complications (<i>p</i> = 0.008), including return to theatre (<i>p</i> = 0.015), and functional issues including asymmetric smile (<i>p</i> = 0.009). No significant differences were observed in readmission rates, length of stay, or time to oral diet commencement (<i>p</i> &gt; 0.05).</p> Conclusions <p>Lip-split procedures remain valuable for resection and reconstruction of oral and oropharyngeal tumours. Lateral lip splits are associated with poorer outcomes when compared to central approaches. Appropriate selection of lip splitting approaches should consider tumour location, resection margins, patient comorbidities and preferences, and surgical preferences.</p>