Abstract Background: Management of oral cancer is always causing dilemma regarding reconstruction of post ablative defects. Submental island flap (SIF) had been widely experienced for restoration of oral integrity. However, presence of its pedicle in the area of neck dissection (ND) raises inquiries about its safety especially in node positive neck. Objective: Assessment of oncological safety of submental flap applied for oral defects after malignant tumor resection and its surgical outcomes as regard comparing disease free survival between node positive and node negative neck. Patients and Methods: A total sample of 56 patients who were diagnosed with oral cancers, were treated by wide local excision and block neck dissection with immediate reconstruc-tion by submental artery island flap (SMAIF) at Surgical Oncology Unit, Mansoura University, Egypt, from July 2014 to December 2020. Results: Data was collected retrospectively including 56 patients aged from 29 to 87 years (mean age 52.5 years old). The mean operative time was (5.25+1.25) hours. The mean blood loss was 460±100. The mean hospital stay was 15±7 days. Patients started oral fluid after a mean time 11.2±2.7 days ranged from. We encountered 16 complicated cases (28.6%) suffered from 24 complications included. Partial flap loss in 3 patients and total flap loss in 2 patients. Intraoral hair growth was the most common complication which oc-curred in 7 (12.5%) patients. After a median follow-up of 35.8 months, mortality occurred in 9 (8.9%) cases; disease-specific in 6 patients while disease recurrences was reported in 11 (19.6%) patients.Four years overall survival was 79% with mean 51.09±2.09 months (CI: 46.9-55.1) and four years disease free survival (DFS) was 74.1% with a mean 48.1±2.4 months (CI: 43.3-53.6). Conclusion: Submental island flap is an excellent option in reconstruction of oral defects after malignant tumor resection with short operative time, short hospital stay but hair growth in male patient must be warned. It is oncologically safe in node negative neck and may be in early non heavy node positive neck provided that preoperative clinical, radiological and intraoperative assessment of sub mental area was free.