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Herein, we present a case of reconstruction of bilateral buccal defects in a 46\u2010year\u2010old patient who had left buccal SCC accompanied with severe OSF. Extensive ablation involved the left full\u2010thickness cheek as well as part of mandible and a release of right OSF tissue were performed. A tripaddled anterolateral thigh (ALT) flap with three independent sets of perforators was harvested for reconstruction. The flap survived in its entirety. No donor or recipient site complication occurred. The preoperative inter\u2010incisor distance (IID) was 1 mm, while the postoperative IID was 23 mm. This is the first report on the use of one tripaddled ALT flap for reconstruction of bilateral buccal defects created from cancer ablation and severe contralateral OSF release. \u00a9 2013 Wiley Periodicals, Inc. 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