The authors retrospectively reviewed 44 patients who underwent a combined transoral and transcervical treatment without mandibulectomy for oropharyngeal malignancy. The combined approach was performed first by a neck dissection followed by transoral excision of the lesion and reconstruction by a forearm free flap. Analysed outcomes included: depth of infiltration; perineural or vascular invasion; feeding abilities; speech and articulation and mouth opening. Multivariate analysis of confounders included age, sex, ASA stage, T and N stages, margins, perineural or vascular spread and capsular rupture. The overall survival at two, three and five years was 98, 90 and 84%. The only negative variable was an advanced ASA score. The DSS (disease specific survival) at five years was 86% with positive margins as a single negative variable. At the functional level only ASA 3 had a negative impact on swallowing and speech. This study demonstrates the value of combined transoral transcervical approaches to oropharyngeal lesions without mandibulectomy. The functional and cosmetic results are better than transmandibular approaches without compromising oncological results.