As the survival rate of tongue cancer has increased, longer-term results of tongue reconstruction are also being considered. The aim of this study was to report the long-term outcomes of total glossectomy.Of 14 patients who underwent total glossectomy, 11 were reconstructed with the rectus abdominis musculocutaneous free flap and 3 with the anterolateral thigh free flap. We reviewed survival rate, swallowing capacity, speech intelligibility, and volume reduction in flaps. Swallowing capacity and speech intelligibility were evaluated by visual analog scale scores (7 points) at 1 to 7 years after surgery, and changes in neotongue volume were examined by dividing volume into 4 stages.The 5-year disease-specific survival rate was 71%. Almost all patients were able to eat a soft diet and resume verbal communication. However, a sufficient volume of the reconstructed tongue was decreased over the course of time. Volume change was more definitive in the cases using the anterolateral thigh free flap than the rectus abdominis musculocutaneous free flap. Neotongue volume was also correlated with swallowing capacity and speech intelligibility.In total tongue reconstruction, wide and thick flaps such as the rectus abdominis musculocutaneous flap had better outcomes. Overcorrection with a sufficient flap volume is recommended for adequate oral intake owing to volume loss caused by radiation therapy, and functional muscle transfer should also be considered to prevent muscle atrophy. Lastly, static suspension procedures are emphasized to prevent airway aspiration for larynx preservation.