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Ideal reconstruction would restore speech intelligibility, facilitate swallowing of liquids and solids without significant dysphagia, and have minimal morbidity. We aimed to review and synthesize published outcomes of tongue reconstructive methods into a useful clinical treatment algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic electronic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses. Medline (OVID), Embase (OVID), PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL) were reviewed for all studies published prior to October 12th, 2024. Conference abstracts, case reports, case series, and review papers were excluded. Quantitative data were extracted and tabulated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After screening 1268 abstracts and 321 full\u2010text articles, 113 papers were included. Multiple free and locoregional flap reconstructive methods, skin grafting techniques, and tissue substitutes were identified. The anterolateral thigh (ALT) free flap and radial forearm free flap (RFFF) were the most common reconstructive methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A treatment algorithm is proposed to facilitate structured surgical planning and intra\u2010operative reconstructive decision\u2010making for tongue malignancy defects.<\/jats:p><jats:p><jats:bold>PROSPERO Registration:<\/jats:bold> CRD420223818875.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.70071","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T08:00:15Z","timestamp":1749715215000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Reconstruction of Tongue Malignancy Defects: A Systematic Review and Treatment Algorithm"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-608X","authenticated-orcid":false,"given":"Peter 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