Reconstruction of total or near-total glossectomy defects has been challenging and the functional outcomes are often disappointing. In this article, the 10-year experience of total or near-total tongue reconstruction at the University of Texas M.D. Anderson Cancer Center is reviewed. The trends of surgical and functional outcomes, length of hospital stay, and choices of flaps and recipient vessels are identified. In addition, the investigators' experience, as well as a literature review, of sensory and motor reinnervation for tongue reconstruction is presented.