## 1 Introduction  
Head and neck cancer accounts for more than 650,000 cases and 330,000 deaths annually; only considering the lip and oral cavity, in 2018 about 355,000 new cases with 177,000 deaths (1.9% of all sites) were reported [1]. In the United States, head and neck cancer accounts for 3% of all malignancies (53,000 cases/year, with about 10,800 dying from the disease), while in Europe, the reported percentage is about 4%, with approximately 250,000 cases, and 63,500 deaths, in 2012 [2; 3].  
The introduction of multimodality treatment has significantly improved overall survival in patients affected by oral cancer, and many efforts have been made in order to improve the quality oflife of these patients, from both an aesthetical and functional point of view. In this context, there is the need for the surgeon to find the \"least invasive\" surgical approach, in terms of potential post-surgical complications (considering that most of these patients require adjuvant treatment) and adequate aesthetical results (avoiding non necessary scars). Obviously, since resection in free margins, including cervical nodes, is the mainstay of treatment for malignant tumors involving the oral cavity, the chances of performing an adequate three-dimensional removal of the tumor are higher if it presents an extensive surgical field that, at the same time, is useful in order to facilitate a flap inset. In the case of tumors arising in the tongue and/or the floor of the mouth without mandibular involvement, the \"pull-through\" technique, in which the primary is resected and pushed down through cervical access, maintaining the integrity of the mandible, has been described [4,5]. Nevertheless, in order to gain wide access to the oral cavity and orophnx, the lip-splitting technique, in conjunction with a mandibular (in which the proximal mandible is swung outwards), has been the preferential approach; also in those cases in which mandibular resection was not required [6]. On the other hand, complications such as mal-union or non-union of the osteotomy, plate failure, wound sepsis, and poor aesthetics are reported after this surgical procedure in a significant number of cases [7].  
Even if today the \"pull-through\" operation is almost universally performed in those cases in which an antero-lateral buccoplectomy and/or partial glossectomy is required, in cases of tumors involving the posterior third of the tongue most surgeons still prefer to perform removal through a transmandibular approach, with or without inferior lip-splitting [8].  
We think that it is possible to use the \"pull-through\" technique for total or subtotal glossectomy involving the posterior third of the tongue. In this regard, we report our experience with 44 patients that underwent \"pull-through\" total or subtotal glossectomy for squamous cell carcinoma involving the posterior tongue, and focusing attention on oncological (incidence of non-radical resection) and reconstructive safety (incidence of complications related to an inadequate flap insetting); since we think that the surgical approach does not significantly influence functional outcome. In fact, the aim of this paper is to counter the opinion, that the \"pull-through\" technique is not safe in the case of tumors involving the posterior third of the tongue.