Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis.

Methods. The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer.

Results. Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved.

Conclusions. The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.