Abstract: Objective To investigate the effects of free forearm flap versus free anterolateral thigh flap reconstruction on life quality in elderly tongue squamous cell carcinoma (TSCC) patients with postoperative defect. Methods One hundred and twenty-nine TSCC patients who underwent complete or partial glossectomy and reconstruction with free flaps from stomatology department in our hospital were grouped according to flap type retrospectively, the number of the case of anterolateral thigh flap reconstruction group was 81 and the number of the case of forearm flap reconstruction group was 48. Oral functions were assessed using the University of Washington Quality of Life (UW-QOL), and the 14-item Oral Health Impact Profile questionnaires (OHIP-14) at 6 and 12 months after reconstructive surgery. Results There was significant difference between two groups in the style of resection (P<0.05). For all oral function domains, the score improved progressively after the operation for 6 and 12 months. The UW-QOL questionnaire showed that there were no significant differences between the two flap types in total scores at 6 or 12 months (P>0.05). The OHIP-14 questionnaire showed that the total score of anterolateral thigh flap reconstruction group was significantly less than that of forearm flap reconstruction group at 6 months postoperatively (P<0.05), there was no significant difference between the two flap types in total scores at 12 months (P>0.05). Conclusion There is no significant difference in quality of life between the two flaps at 12 months postoperatively in elderly TSCC patients with postoperative defect. Free forearm flap reconstruction should be suitable for patients with part-tongue glossectomy, and free anterolateral thigh flap reconstruction should be fit for the patients with total-tongue glossectomy.