The band members mostly composed the music individually, in stark contrast to the writing process for Butchered at Birth, which was a substantially collaborative effort (though Rob Barrett would later claim to have co-written several songs on The Bleeding).

[6] Although songwriting was not credited to individual members as with later Cannibal Corpse releases, according to Owen, Rusay composed much of "Post Mortal Ejaculation" and "Beyond the Cemetary."

"[10] Because the liner notes on Butchered at Birth feature quotations from American serial killer Albert Fish, he is often incorrectly credited with being the voice at the beginning of "Addicted to Vaginal Skin," which Chris Dick of Decibel described as "revolting".

"[19] Paul Mazurkiewicz stated that although the infamous bassline in "Hammer Smashed Face" was in his view "a little primitive," it was considered technical by the genre's standards in 1992.

Vice also said the album "sounds like death metal as pop—the genre stripped to its basics, a template that launched thousands of bands since.

"[22] According to Invisible Oranges, "there’s a deep guttural rhythmic quality to the album not unlike a tribal drum or an excited heartbeat.

"[13] According to Invisible Oranges, the album's guitar work "ranges from writhing Tesla coil leads to pulpy chugs.

We always wanted the bass to be heard, more so on Tomb Of The Mutilated than any of the previous records.”[25] The album has been noted for the "belching" vocal performance of Chris Barnes, which consists of largely incoherent death growls.

[14] The album's lyrical content explores themes such as sexual violence, sadism, mutilation, disembowelment, castration, necrophilia, incest, coprophagia, vampirism, corpse decomposition, blunt trauma, pedophilia, foeticide, cannibalism, insanity, exhumation, infanticide, homicide, mass murder, suicide and the undead.

According to Invisible Oranges, "Where before the band had wallowed in a more simplistic, and in its own way incredibly enjoyable, sense of excessive violence, Cannibal Corpse came out of 1992 with something darker and scarier, a beast with a unified vision of horror from which it was impossible to look away."

Dom Lawson of Metal Hammer wrote that the album is "bulging with moments of stomach-churning horror" and called its lyrical content "provocatively over-the-top."

Chris Dick of Decibel recalled that the album's lyrics made him "feel ill" while reading them as a teenager, saying "I thought if I was caught with the sleeve I'd be expelled or placed in some type of protective custody.

"[31] Barnes said the intent behind his lyrics was "invoke thought" by "[sickening] [...] and yet [entertaining]" readers with what he called a "twisted dichotomy," which he compared to "watching a horror movie.

"[32] Sociologist Natalie J. Purcell assessed the album's fifth track, "Necropedophile," as "[offering] Barnes' speculation on the inner workings of the deranged mind driven to murder children and rape their dead bodies.

The album's seventh track, "Entrails Ripped From a Virgin's Cunt," which has been called "arguably the most offensive song in the Cannibal Corpse canon," is based on a story that a former prison employee had recounted to Barnes about two inmates who were serving life sentences for kidnapping a young girl and raping and disemboweling her with a coat hanger, which Barnes was deeply disturbed by.

The site described the album artwork as "two ivory-skinned gutted lovers caught in an act of mortal cunnilingus, the ambience set with candles, a rotting severed head, and a butcher knife.

Metal Blade Record president Brian Slagel reportedly rejected the original incarnation of the album artwork because it was not "gory enough," so Locke added deep lacerations to the female zombie's face, neck, thighs and wrists.

The original incarnation of the album art also did not feature the blue and grey tones on the zombies' skin, and the corpses were initially entirely white.

Heavy metal webzine Kicked in the Face praised the album's musicianship but criticized the tone of Barnes' vocals and Scott Burns' production.

"[13] In 2017, Decibel wrote, "death metal bands are still trying to create something as outwardly offensive and antisocial as the Hall of Fame-certified Tomb of the Mutilated and falling short.

"[43] Joe DiVita of Loudwire said "Tomb of the Mutilated brought Cannibal Corpse to the forefront of the genre, now fully equipped to compete with contemporaries like Morbid Angel, Death and Suffocation.

"[21] Vincent Jefferies of Allmusic argued that the "powerful musical focus" of Cannibal Corpse's early albums, including Tomb of the Mutilated, have contributed to the band's longevity and lasting impact.

He explained, "Learned fans have come to appreciate Tomb of the Mutilated as a solid, if not important, offering [...] Cannibal Corpse somehow managed to outlast many of their more critically accepted contemporaries due in no small part to early career efforts like [this one].

"[35] Current Cannibal Corpse guitarist Rob Barrett has called Tomb of the Mutilated his favorite album by the band, saying "the energy level is amazing on it".

[8] Trivium guitarist Corey Beaulieu claims his mother confiscated his copy of Tomb of the Mutilated when he was a teenager after reading the album's song titles.

[8] Late The Black Dahlia Murder vocalist Trevor Strnad claimed he had to shelve the album after purchasing it, recalling "me and my bowl cut and my Harry Potter glasses are not ready for this shit".

[8] "Hammer Smashed Face" was featured during the band's cameo appearance in the 1994 comedy film Ace Ventura: Pet Detective starring Jim Carrey.