Oral tongue is a part of oral cavity. Oral tongue made up six pairs of muscles (extrinsic and intrinsic) and demarcated into four anatomic area (tip, lateral borders, dorsal border and ventral surface). Tongue helps in speech, swallowing and taste sensation.

Non healing painless or painful ulcer, whitish or reddish patch, lump over neck, ear pain is common presentation. Biopsy is needed to confirm diagnosis.  MRI gives better soft tissue delineation and preferred imaging modality for tongue cancer for primary tumor extent. CT scan is required to rule out metastasis. For locoregionally advanced disease, PETCT scan may be required to rule out metastasis.

Wide local excision with negative surgical margin in the form of partial, hemi, subtotal, near total or total glossectomy and unilateral or bilateral neck dissection is recommended treatment for tongue cancer, depending upon extent and stage of the disease.

Reconstructive plastic surgery is required for more than hemi glossectomy defect. For surgical defect more than one third to one half, reconstruction is optional depending upon patient’s preference. For smaller defect, local flap is a good option, especially in female. For larger defect, reconstruction with free soft tissue flap in the form of radial forearm free flap or anterolateral thigh (ALT) free flap is recommended. Reconstruction of tongue defect, helps in early restoration of speech and swallowing. Majority of patients are able to speak and take oral diet after reconstruction. Final functional outcome also depends upon extent of resection and type of reconstruction.

Post operative adjuvant radiotherapy is required depending upon histopathology report. Concurrent chemotherapy with postoperative radiotherapy is required for positive surgical margin and extra capsular extension of nodal metastasis.