Objectives <p>The intraoral anastomosis technique (IAT) is an approach that consists of performing microvascular anastomoses within the oral cavity. It avoids cervical incisions and oro-cervical communication. Although widely described using the facial pedicle, its application to the lingual pedicle remains poorly documented. This study aims to describe the surgical anatomy, technical feasibility, and clinical relevance of IAT using the lingual vascular network for tongue reconstruction following partial glossectomies and hemiglossectomies.</p> Materials and methods <p>A detailed review of tongue anatomy and vascularization was conducted, emphasizing the deep lingual and sublingual arteries and veins. A surgical protocol for IAT using thin fasciocutaneous free flaps was developed. One illustrative clinical case of mobile tongue reconstruction using a free superficial circmflex iliac artery pertorator (SCIP) flap with IAT is presented.</p> Results <p>The deep lingual artery and vein were identified intraoperatively and used for successful microanastomoses with a free SCIP flap. Postoperative outcomes demonstrated optimal flap viability and successful functional rehabilitation.</p> Conclusions <p>IAT using the deep lingual or sublingual pedicle may be a feasible and functionally effective alternative for tongue reconstruction after type II and IIIa glossectomies. This surgical protocol enables minimally invasive full-thickness reconstruction thereby facilitating optimal functional rehabilitation with reduced surgical invasiveness.</p> Clinical relevance <p>In selected patients, lingual IAT enables quality tongue reconstruction with thin free flaps while reducing surgical invasiveness. Further anatomical and clinical studies with larger cohorts are warranted to validate its routine application.</p>