Introduction First described in 1929, lateral pharyngotomy (LP) is a surgical approach exposing the oropharynx/hypopharynx whilst avoiding a morbid mandibulotomy. With advancements in transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and primary radiation, LP has been utilised less frequently in modern practice. For patients not amendable to TORS or TLM resection, LP offers an alternative to invasive mandibulotomy or primary radiation both of which carry significant morbidity and post-operative complications. Clinical Case A 61-year-old male presented to the otolaryngology, head and neck clinic with an exophytic left base of tongue mass. His social history included a 28-year pack history of smoking. MRI revealed a 24mm left base of tongue lesion, confirmed as an adenoid cystic carcinoma (T2 N0 M0) on microlaryngoscopy and biopsy. The patient underwent a lateral pharyngotomy with wide local excision of the lesion plus tracheostomy. Post-operative histopathology revealed negative margins 5mm deep and 10mm peripheral with no perineural invasive. De-cannulation occurred two days post without issue. Post-operative recovery was complicated by delirium, dysphagia, and aspiration all which resolved completely with a length of hospital stay of 15 days. Conclusions The LP approach is a viable option to access the oropharynx, tongue base and hypopharynx if factors such as the patient, disease and institutional access prevent utilisation of TORS or TLM resection. It can also spare patients from significant morbidity associated with mandibulotomy and possible primary or adjuvant radiotherapy.