Access Procedures: Visor Flap, Lip Split, Mandibulotomy, and Lingual Release

Due to the access challenges of the operating through the oral cavity, advanced oral and oropharyngeal cancer resections are not always amenable to standard transoral resection. Access procedures may need to be considered to provide adequate exposure for direct visual examination to achieve complete tumour extirpation and adequate surgical margins and to facilitate reconstruction where possible. The choice of which procedure to employ depends on the size and location of the tumour and the best approach to preserve function, minimise complications, and maximise cosmetic outcome. The chapter discusses the visor flap, lip split mandibulotomy, and lingual release (or drop down). Tips on how to achieve the best functional and cosmetic result are discussed and alternatives presented. The head and neck surgeon should be able to perform each of these techniques where necessary, knowing the limitations and advantages of each. Despite the advent of transoral laser surgery (TOLS) and transoral robotic surgery (TORS), these access procedures still have an important place in the management of advanced and salvage oral and oropharyngeal cancers.