Glossectomy defects are commonly reconstructed with rectus abdominis myocutaneous flaps or radial forearm flaps depending on the size of the defect. To minimize donor site morbidity, sixteen consecutive anterolateral thigh (ALT) free flaps were performed in a period of seven months by a single surgeon for head and neck reconstruction: eleven for tongue, three for temporal-orbital-maxillary and two for pharyngoesophageal reconstruction. All flaps survived without partial necrosis. The average age was 63 ± 11 years with a body mass index of 25.5 ± 4.5. A perforator near the midpoint between the anterior superior iliac spine and superolateral patella (perforator B) was present in all the cases; only two of them were septocutaneous. A more distal perforator (perforator C) was present in eleven cases, which was musculocutaneous in each case, while a more proximal one (perforator A) was present in eight cases with five being septocutaneous. The average pedicle length to the perforator A was 10.9 ± 2.5 cm, while that to the perforator B was 14 ± 2.8 cm. The average thickness of the flap at the level of the perforator B was 15.5 ± 5.9 mm (range 5 to 30 mm). In the eleven glossectomy cases, eight were total or subtotal and three were hemi-glossectomy defects. Three patients also underwent segmental mandibulectomy and free fibular flap reconstruction. In each case, a portion of the flap was deepithelialized to reconstruct the floor of mouth; the larynx or hyoid bone was re-suspended to the mandible. Extensive thinning of the flap was performed in an obese patient. The flap thickness was reduced from 30 mm to 5 mm without compromise of blood supply to the flap. All patients were decannulated. Modified barium swallow studies were performed postoperatively in all patients to assess swallow function and leakage. A small contained leak was found in one patient, which healed spontaneously. Prolonged aspiration was present in two patients whose resection included anterior mandible and extended to the epiglottis. Consequently, they were tube feeds dependent. Excellent speech and deglutition occurred in the remaining patients. The lateral femoral cutaneous nerve was included as a sensate flap in six patients with the lingual nerve as the recipient nerve in each case. All patients regained sensation to certain degree. It was concluded that the ALT flap is well suited for tongue reconstruction with minimal donor site morbidity. Flap thinning may be needed for hemi-glossectomy defects.