In China, it is the most common cancer in the oral cavity compared with cheek cancer, gum cancer, palate cancer and floor of the mouth cancer. The overall five-year survival rate is 31%-66%. Like other cancers, the real causative factors of tongue cancer are not clear. However, its occurrence is closely related to tobacco and alcohol addiction, chronic inflammatory stimulation and damage in the oral cavity, such as damage to residual roots and crowns and bad restorations, microcurrent stimulation caused by the coexistence of two metal materials in the mouth, precancerous lesions such as leukoplakia, oral submucosal fibrous changes, flat moss and other long-term untreated evolution can lead to malignant transformation and tongue cancer. The age of onset is mostly above 40 years old, but there is a trend of rejuvenation in recent years, from 11 to 97 years old, more concentrated in middle and old age. However, due to the lack of popular education on oral cancer prevention and treatment and regular oral examination, a considerable number of tongue cancer patients are already in the middle and late stages when they are diagnosed. Clinically, tongue cancer is usually of ulcerative or infiltrative type, often occurring at the edge of the tongue, with early symptoms similar to oral ulcer, pain and limited tongue movement. As the lesion develops, it spreads to the tongue muscle, the floor of the mouth and the mandible, causing difficulty in speech and swallowing. The lesion involving the mandible needs to be examined by panoramic film or CBCT. MRI enhancement and CT enhancement can assist in determining the extent of lesion and lymph node metastasis, and ultrasound examination has reference value in assisting in determining lymph node metastasis. Lung CT scan can be performed for advanced tongue cancer with suspected lung metastasis. Preoperative biopsy and intraoperative frozen pathology can confirm the diagnosis, and margin examination can ensure clean resection of the lesion. [Differential diagnosis] Necrotizing peri-mucous gland ulcer is larger than recurrent stomatitis, often larger than 0.5 cm, usually no more than 2 cm in diameter, deep to the submucosa and muscle layer, mostly solitary, with irregular margins and surrounding inflammatory infiltration and elevation. The duration of the disease is much longer than 7-10 days, usually about 1 month, and can heal spontaneously. Soft to palpation. Traumatic ulcers Oral ulcers caused by defective denture or residual roots and crowns are easily misdiagnosed as squamous cell carcinoma, especially when there is inflammatory edema in the surrounding tissues, but they are soft to touch, without infiltrative hard masses, and can improve significantly within a few days by removing the irritating factors. Tuberculous ulcer The ulcer is irregular in shape, with elevated subterranean edges, and may have purulent secretions or yellowish pseudomembranes on the surface, which can be removed to reveal red granular granules with uneven bases, and the base is not hard. There may be systemic tuberculosis symptoms. The first surgical excision is the key to cure. If the surgery is not clean, even though postoperative radiotherapy or/and chemotherapy can inhibit the growth of cancer cells, at this stage, the possibility of cure almost does not exist. Therefore, routine intraoperative pathological examination of surgical margins should be strongly advocated to strive for a clean surgical excision. The general resection range should include 1 to 2 cm of normal tissue outside the tumor. For T1 and T2 patients, postoperative radiotherapy or chemotherapy is not necessary for those with complete lesion resection. In addition, exploration of the anterior lymph nodes can help to determine the metastasis of the lymph nodes. The concentration of isotope or dye in the lymph nodes only indicates that the lymphatic return from the tumor site reaches the lymph nodes first, it does not indicate absolute metastasis, but is only a reference basis for the scope of cervical lymphatic clearance. For superficial and small lesions, freezing, laser and surgery can be used to achieve good results. If the lesion is extensive, the floor of the mouth is involved, or if it is recurrent, as long as the systemic condition allows, a combination of surgery, radiotherapy, chemotherapy and immunotherapy should be adopted, and conservative treatment is not advisable. In order to cover the trauma and restore the shape and function as much as possible, it is often necessary to reconstruct and rehabilitate the tissue. Commonly used flaps for tongue defect repair are: Chinese flap, i.e. radial flap of forearm with vascular free graft; due to various factors and defect size, sometimes frontal flap, pectoralis major muscle flap, shoulder deltoid muscle flap, latissimus dorsi muscle flap, fibula composite flap, etc. Radiotherapy For elderly patients, due to the limitation of systemic condition, palliative conservative treatment methods are relatively more applied, especially for tongue root cancer, simple radiotherapy can be considered, and it is recommended to use short-range radiotherapy (brachytherapy), a kind of rear-loading therapy machine treatment, which has accurate localization, less damage to normal tissues, and is a kind of local radiotherapy with high radiation dose. Cases that are not sensitive to radiotherapy and can still be operated need to discontinue radiotherapy in time to leave an opportunity for surgery; otherwise, continuous high-dose radiotherapy does not control the development of lesions, and radioactive jaw necrosis can occur, resulting in non-healing postoperative wounds and making local repair difficult. Chemotherapy Postoperative chemotherapy is preferable to start 2-3 weeks after surgery, when the new blood vessels at the surgical site have just started to form and the drugs happen to reach the local area through rich blood flow. After radiotherapy, local endovascular inflammation, narrowing of the vascular cavity and reduction of blood flow make chemotherapy less effective. At present, local chemotherapy of tumor is also gradually carried out, and the new anti-cancer concept of slow-release library is gaining success. With the use of slow-release technology and injection technology, the anti-cancer drugs are concentrated in the tumor area, and their half-life is tens of times longer than that of intravenous application, and they can kill cancer cells rapidly and permanently after being injected into the tumor tissue. Since the injected drug stays inside the tumor and does not participate in blood circulation, it has no obvious toxic side effects and protects normal tissues at the same time. Cisplatin microspheres, adriamycin microspheres and mitomycin microspheres for injection combine transarterial embolization and drug slow release, which also improve the efficacy and reduce the toxic side effects. Preoperative radiotherapy and neoadjuvant chemotherapy, as well as simultaneous radiotherapy, can improve the efficacy. Biological therapy Molecular targeted therapy and immunotherapy are developing rapidly and have been gradually used for tongue cancer treatment. Chinese medicine treatment can be used as an adjuvant throughout the treatment process. 【Practice experience】 Clinical manifestations of tongue cancer are closely related to prognosis: exophytic type generally has no conscious symptoms or mild symptoms, slow growth, clear boundaries, better results after resection, and the resection range can be limited to normal tissues within 1 cm outside the tumor; this type is relatively rare clinically, and is seen in elderly patients with early cancerous changes of papilloma or leukoplakia. The depth and speed of infiltration are the main factors in the prognosis of tongue cancer, and an infiltration depth of 4 mm or more is sufficient to cause metastasis. Although the infiltrating hard nodes are not large on palpation, the mucosal congestion and edema around the hard nodes are obvious, suggesting that the invasiveness is very strong, and although the cut edge is negative during surgery, the metastasis will still recur soon. measures should be applied as soon as possible, with special attention to immunomodulation. Although the degree of differentiation is a recognized prognostic indicator in the medical field, we found in our clinical practice that a considerable number of patients are pathologically highly differentiated, but the recurrence and metastasis are more obvious and the prognosis is not good. If a mass is found at the root of the tongue due to more lymphoid tissue, clinically similar to squamous cell carcinoma, we should be alert to malignant lymphoma and recommend preoperative excisional biopsy. Although many kinds of musculocutaneous flaps such as Chinese flap are used for repair of tongue cancer after resection, due to the multi-directional distribution of lingual intrinsic muscle, it can move freely under the innervation, while the repair of rectus abdominis musculocutaneous flap with nerve still restores the shape and covers the trauma so far, although subjectively, we want to restore its function. Therefore, when the lesion is extensive and involves the tongue root, the movement will be limited after resection despite the flap repair, and it will be difficult for the epiglottis to cover the vocal folds normally during swallowing, causing choking and aspiration pneumonia, requiring tracheotomy and maintenance until function is restored. For postoperative review patients, local recovery of any pre-existing symptoms is indicative of recurrence, and granulation-like changes around the incision despite the absence of ulceration and exclusion of threads at the base must be highly suspicious of recurrence and decisive excisional biopsy.