Comparison of Postoperative Outcomes in Two Lip-Splitting Approaches for Buccal Squamous Cell Carcinoma Ablation.

Abstract

Objectives: The choice of surgical access for resection and reconstruction of buccal squamous cell carcinoma (BSCC) with the lip-splitting incision is controversial. Thus, this study aimed to evaluate the clinical and functional outcomes of midline lip split with lazy-S incision (MLSI) against the lateral lip-splitting incision (LLSI).

Methods: A retrospective review was conducted on 41 patients with primary BSCC who underwent resection and reconstruction using MLSI approach (n = 19) and LLSI approach (n = 22) between 2022 and 2024. Functional outcomes, including skin sensitivity testing, oral competency, lip movement, cold perception, and other relevant measures, were evaluated with appropriate scales. Functional satisfaction and Patient and Observer Scar Assessment Scale (POSAS) were analyzed.

Results: None of the patients in either group demonstrated differences in sensation to light touch from baseline at 6 months postoperatively. Patients with MLSI approach reported higher lip function satisfaction (p = 0.037), and no patients in either group reported drooling. Besides, groove formation was significantly more common in the LLSI compared to the MLSI groups (50% vs. 15.8%, respectively; p = 0.046). A statistically significant difference was also observed in the self-assessment of mouth-opening movement among MLSI patients (p = 0.041). No significant differences were found in the mean POSAS scores, except that irregularity and surface area parameters were better in the MLSI group.

Conclusions: Objective sensation deficits are reversible and do not impact long-term daily activities. The MLSI approach provides better postoperative outcomes and low disfigurement perception.