Total glossectomy, with or without accompanying total laryngectomy, in many respects represents the radical extreme of the treatment spectrum for oral cavity/oropharyngeal carcinoma. It necessarily impacts greatly upon the functions of speech and deglutition and thereby upon the patient's quality of life. The candidates for this surgical procedure are, however, already severely debilitated with respect to these functions due to the extent of their disease and tumor-induced pain. When considering the alternatives, radical surgery becomes more acceptable, for, at the very least, it offers substantial palliation. This article reviews the current literature regarding the procedure itself, potential outcomes and presents a small case series of reconstructive options.