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To determine the efficacy of ethanol embolisation in management of tongue vascular malformations.Thirty-nine patients (22 females, 17 males; mean age: 38 years) presented with tongue vascular malformations. Forty-seven patients had undergone 61 failed previous procedures (embo, laser, surgery, steroid injection, alpha-interpheron, radiation). All patients had baseline arteriograms and MRs. All patients underwent direct puncture ethanol therapy.Of 39 patients with venous-lymphatic malformations, 27 patients had dramatic reduction and 12 patients’ therapy is on-going with concurrent reductions (mean f/up: 60 months). One patient with mixed veno-lymphatic malformation required surgical debulking of excess tissues (>90% after treatment). Minor complications such as tongue blisters (9 instances) healed spontaneously; 3 tongue mucosal injuries healed spontaneously; 3 infections responded to antibiotic treatment; 1 area of hemi-focal numbness resolved.Ethanol embolotherapy is a primary form of therapy to eradicate low-flow vascular malformations of the tongue permanently at long-term follow-up. Rarely is concurrent surgery required except to debulk an enlarged tongue that shrink minimally after treatment of the underlying vascular malformation. Low complications are encountered. Partial or total glossectomy should be avoided.W. Yakes: None.