Purpose of Review: To describe the current knowledge about tongue base surgery (TBS) in obstructive sleep apnea (OSA). Diagnostic tools and surgical techniques developed during the last years will be illustrated. Recent Findings: Tongue base (TB) obstruction can be objectively assessed in a multidisciplinary way through polysomnography, DISE, imaging studies, and measurements of tongue strength. Transoral approaches for TBS include midline glossectomy, radiofrequency TB reduction, coblation TB reduction/resection, and TORS. Transcervical approaches include TB suspension techniques and the newly described upper airway stimulation surgery (UAS). A description of each technique is made. Summary: Selecting a successful surgical approach depends on many factors such as the age of the patients, AHI severity, patient’s airway collapse pattern, body mass index, surgeon experience, and patient’s preference. It is important to discuss also surgical treatment expectations, pain, rapid recovery, and disposition to undergo device implantation. TB approach can be used as part of a single procedure or as part of a multilevel approach.