Risk Factors Predicting Aspiration After Free Flap Reconstruction of Oral Cavity and Oropharyngeal Defects

Abstract

To determine risk factors predicting early postoperative aspiration in patients after microvascular free flap reconstruction of oral cavity and oropharyngeal defects. Retrospective analysis. Academic tertiary care referral medical center. The study included 100 patients who underwent resection of oral cavity or oropharyngeal tumors with immediate free flap reconstruction of the defect. Dysphagia severity was assessed by modified barium swallow study performed within 90 days after surgery to determine the presence or absence of tracheal aspiration. Aspiration risk factors analyzed included age; sex; tumor T and N stage; comorbidity level (American Society of Anesthesiologists classification); preoperative swallowing function; history of tobacco use; surgical approach used for tumor resection; defect classification; type of free flap; history of radiation therapy, surgery, and/or chemotherapy; and surgical defect classification. The following risk factors were significant predictors of postoperative aspiration on univariate analysis: prior radiation therapy (P < .001), tongue base resection classification (P = .001), tumor N stage (P < .001), hypoglossal nerve sacrifice (P = .004), and presence of a mandibular osteotomy (P = .01). On multivariate analysis, only a history of radiation therapy (P = .002) and tongue base resection (P = .008) remained statistically significant predictors of aspiration. Patients with resection of more than half of the tongue base and patients with a history of radiation therapy are at high risk of having early postoperative aspiration after free flap reconstruction.