Purpose: The aim of this study was to assess the number of complete resections and recurrence rates in oral and oropharyngeal squamous cell carcinoma treated with intraoperative narrow-band-imaging. Materials and methods: In this observational study, superficial resection margins of oral and oropharyngeal squamous cell carcinoma were intraoperatively defined using narrow-band-imaging. The number of complete resections was assessed. Patients were followed up for at least 5 years: disease free survival and the cumulative incidence of local recurrence were recorded. Results: 93 squamous cell carcinoma were considered. Surgical resection was complete in 84.9 % of cases. The 5-years disease free survival was 76.2 % (95%CI: 67.1 %–84.4 %). Cumulative incidence of local recurrence was 9.7 % (95%CI: 4.7 %–16.7 %), lower compared to previous literature: it was higher in patients over 68 years (14.3 %, 95%CI: 6.2 %–25.6 % vs 4.5 %, 95%CI: 0.8 %–13.8 %) although without statistically significance. Conclusions: In oral and oropharyngeal squamous cell carcinoma surgery, narrow-band imaging is a valuable tool for accurately identifying the true superficial extent of the tumor, facilitating complete resection and potentially reducing local recurrence.