Cancer of the base of the tongue and the larynx is usually treated primarily with irradiation to 6,000 rads. Persistence of tumor after irradiation is common and requires a logical, thoughtful approach designed to augment all tissues removed. Careful preoperative planning and the use of the lateral approach to the base of the tongue, in conjunction with pharyngostome and laryngostome formation allows wide resection of the cancer. Preservation of the function of speech and swallowing, and preservation of the mandibular contour are important, and correlate closely with carotid artery protection. Five different methods of approach to the problem are analyzed and presented.