Advanced oral cavity squamous cell carcinoma (OSCC) of the tongue is an expression of tumor aggressiveness and progression through infiltration of extrinsic muscles. In advanced cases, the risk of neurovascular and lymphatic tissue is high; therefore, total excision en bloc of the oncological compartment is mandatory in order to achieve oncological radicality and reduce local recurrence. For that reason, compartmental surgery for cT3-4 encompasses neck dissection, excision of involved extrinsic tongue muscles from their bony insertion, scarification of lingual and hypoglossus nerve, and finally tumor radical removal after a pull-through maneuver. This chapter gives a practical step-by-step detailed explanation of standard hemi-compartmental surgery. An ordinary presentation of the surgical procedure is demonstrated on cadaveric figures with the aim of simplifying some of its important steps. Finally, other extra-compartmental and variants of this surgery will be discussed in order to demonstrate the modularity of this surgery when applied in specific case where different structures and areas of the tongue are involved in the so-called oncological compartment.