Visor Flap Approach for Oral Cavity Cancer

The visor flap approach is a surgical technique used for extensive access to the mandible and oral cavity:
- By elevating the facial skin from the chin and cheeks, often extending from mastoid to mastoid
The visor flap approach:
- Provides sufficient exposure for anteriorly located lesions:
  - But is not satisfactory for tumors
    located in the posterior oral cavity
- The benefit of this approach:
  - Is that it avoids a lower lip–splitting incision:
    - But produces permanent numbness of the chin:
      - Because the mental nerves
        need to be transected for adequate mobilization of the flap
    - It also may cause sagging of the lower lip and drooling:
      - Because of a loss of support and sensation
  - Thus its utility is limited
Key Aspects of the Visor Flap Approach:
- Incision and Elevation:
  - A horizontal incision is made in a natural neck crease:
    - Often from mastoid tip to mastoid tip
  - The flap is raised in a subplatysmal plane up to the inferior border of the mandible:
    - Then superiorly to expose the cheek and chin:
      - Avoiding injury to the marginal mandibular nerve
- Indications:
  - Primarily used for large, advanced anterior oral cavity or oropharyngeal tumors, mandibulectomies, and mandibular reconstructions
- Advantages:
  - Excellent vascular supply, no lip-splitting scar, and good access to the neck for dissection
- Disadvantages:
  - Potential for anesthesia of the chin skin due to sacrifice of mental nerves
- Application:
  - It is often paired with a tracheotomy for airway management and can be combined with lingual release or mandibular osteotomies if necessary