Background <p>Tongue squamous cell carcinoma (TSCC) is one of the most common malignancies of the oral cavity, and cervical lymph node status is a major determinant of prognosis. Conventional selective neck dissection (SND) requires a transcervical incision that may result in visible cervical scarring and reduced patient satisfaction. Natural orifice specimen extraction surgery (NOSES) offers a minimally invasive alternative by enabling transoral specimen retrieval while preserving specimen integrity and avoiding an additional cervical incision. This study aimed to evaluate the technical feasibility and preliminary clinical outcomes of NOSES-facilitated transoral en-bloc specimen extraction combined with a modified facelift incision and endoscopic selective neck dissection in patients with clinically node-negative TSCC.</p> Methods <p>This retrospective single-center case series included seven patients with clinically cT1–3N0 TSCC who underwent hemiglossectomy with in-continuity endoscopic selective neck dissection through a modified facelift incision. Transoral en-bloc specimen extraction was performed using the NOSES technique, and indocyanine green (ICG) near-infrared fluorescence imaging was used intraoperatively for lymphatic mapping and assessment of free flap perfusion. Perioperative outcomes, postoperative complications, cosmetic outcomes, and short-term oncologic outcomes were evaluated.</p> Results <p>All procedures were completed successfully without conversion to a conventional transcervical approach or major intraoperative complications. A mean of 15–16 cervical lymph nodes was harvested per patient, and no pathological cervical lymph node metastases were identified. One patient developed partial free flap necrosis, which resolved following appropriate management. During a follow-up period of 23–36 months (replace with the exact mean or median if available), no local recurrence or cervical lymph node metastasis was observed. All patients achieved favorable cosmetic outcomes, with low postoperative neck scar scores.</p> Conclusions <p>This preliminary case series demonstrates that NOSES-facilitated transoral en-bloc specimen extraction combined with a modified facelift incision is technically feasible in carefully selected patients with clinically node-negative TSCC. The technique achieved acceptable short-term perioperative, cosmetic, and preliminary oncologic outcomes. However, larger prospective comparative studies with longer follow-up are required to confirm its long-term safety, reproducibility, and oncologic effectiveness.</p>