Traditional methods of repair for medium-size (3-5 cm) oral defects include allowing granulation, primary closure, skin grafts, and buccal mucosal grafts. Each of these methods has several disadvantages, and all tend to result in significant scar contracture and often lack sufficient bulk. In 10 patients, the defect left by resection of cancer lesions was reconstructed with a free palatal mucoperiosteal graft. In all patients, the grafts survived with little contracture, allowing for adequate tongue mobility. Because of the thickness of the palatal mucoperiosteum, local depressions typically associated with floor of the mouth defects could be avoided. The palatal donor site was left to granulate and recovered in 2-3 weeks with little residual deformity. In 4 patients a through-and-through resection of a floor of the mouth cancer was performed in continuity with a neck dissection. A palatal mucoperiosteal free graft was utilized exclusively in the reconstruction, without the development of salivary fistula.