Upper Aerodigestive Tract Research Articles

Assessment of Professional Practices in the Care Pathway of Patients with Upper Aerodigestive Tract Cancer in a University Hospital.

The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies. This retrospective, single-center study was conducted at a tertiary referral center and included 147 patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract. Patients were divided into two groups based on the match between MTM-decided and actual treatments. Multivariate analysis was performed to assess factors independently associated with discrepancies. Out of 147 patients, 28 (19%) received treatment that did not align with MTM decisions. Among these, eight died before treatment, one patient refused care, five received supportive care, five patients underwent surgery, three received radiotherapy alone, one patient underwent surgery and adjuvant radiochemotherapy, one patient underwent surgery and adjuvant radiotherapy alone, three patients received radiochemotherapy, and one patient received palliative chemotherapy. Independent significant factors associated with non-concordance included poor performance status (PS) and treatment not received at a tertiary reference center. Treatment shifts mainly involved downgrading from curative to palliative care. This study highlights the importance of patient health status in determining deviations from MTM decisions. Further efforts should focus on improving the integration of patient comorbidities and health status into MTM decision-making to optimize care delivery.

The Diagnostic And Prognostic Role Of Immunohistochemistry In Head & Neck Tumours Along With Radiological & Histopathological Study

Background: Head & neck tumors are defined as benign, premalignant & malignant tumors above the clavicles, except the tumors of brain, spinal cord and esophagus. This includes tumors of paranasal sinus, nasal cavity, salivary glands, thyroid and upper aerodigestive tract, lymph nodes of neck, skin & its appendages, soft tissue tumors, midline carcinomas & metastatic tumors. Ultrasonography, computed tomography, magnetic resonance imaging were the modalities for initial evaluation. Histopathology was the GOLD standard for diagnosis followed by IHC for confirmation because correct diagnosis & cancer subtyping of the neoplasia is essential for successful therapy and prognosis. Materials & Methods: Study was conducted for 2 years with 100 specimens of head & neck tumors. Thorough Radiological investigation was done followed by Histopathological examination including biopsy & whole resected specimens. IHC markers appropriate to the histopathological diagnosis was done. Results: Among 100 patients of head & neck tumors, most belonged to 5th decade with male: female ratio of 2.3:1. Squamous cell carcinoma (66%) followed by Lymphoma(11%), tumors of salivary glands(8%), metastatic lymphadenopathy(7%) were the lesions present. SCC was most common carcinoma in oral cavity, larynx, nasopharynx and ear with positive p63 marker. 1 case of Basal cell carcinoma with positive BerEP4 & in NHL, salivary gland tumors & Metastatic lymphadenopathy panel of IHC were included for confirmation. Conclusion: Immunohistochemistry has a diagnostic & prognostic role in Head & Neck tumors along with Radiological & histopathological examination.

The Impact of Vocal Tremor on Deglutition: A Pilot Study.

Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor-related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology. Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire. Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL-QOL or PAS between tremor phenotypes. SWAL-QOL scores revealed that these patients rarely reported dysphagia symptoms. Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population. 4 Laryngoscope, 134:4599-4603, 2024.

Behavioral Interventions for Tobacco Cessation in Low and Middle-Income Countries: A Systematic Review and Meta-analysis.

An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers including upper aero-digestive tract cancer, stomach cancer, ischaemic heart disease (IHD) and stroke; with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially. We synthesised the effectiveness of behavioural interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioural intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at six months post-intervention follow up. For continuous abstinence at six months, the intervention was superior to active comparator (RR 2.32; 95% CI 1.78-3.02), and usual care (RR 4.39; 95% CI 2.38-8.11). For point prevalence abstinence at six months, the intervention was superior to active comparator (RR 1.76; 95% CI 1.28-2.44), and usual care (RR 2.37; 95% CI 1.47-3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons, except for 6-month continuous outcomes. Implementation research is needed to understand factors for programme sustainability and equity of impact of behavioural interventions in reducing tobacco use in LMICs. Our review is an important step towards the understanding of effectiveness of behaviour interventions for tobacco cessation suited for low- and middle-income countries and which are responsive to the contextual needs of such countries.

NUT Midline Carcinoma at the Anterior Skull Base - A Case Report

An uncommon and severe form of human malignancy is called NUT midline carcinoma (NMC). The mediastinum or midline of the upper aerodigestive tract contains the majority of NMCs. A chromosomal rearrangement affecting the NUT gene, which produces oncoproteins regarded as a major pathogenic driver of cellular transformation, is the genetic cause of NMC. When a commercial antibody against NUT is available, NMC can be diagnosed, and the diagnosis is confirmed by positive nuclear immunohistochemistry staining. There is no standard treatment for NMC to date. There may be a multimodal approach for NMC such as chemotherapy, surgical intervention, and radiotherapy adopted currently in clinical practice. Despite aggressive radiation therapy and chemotherapy, the typical survival is less than 1 year. The majority of cases with NMC die due to local complications of the tumor or complications due to treatment. Here, we are presenting a case of NMC in young adults with isolated involvement of the anterior skull base with bony erosion and intracranial extension.

Radioanatomy of Salivary Glands

Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.

Contribution of Imagery in Larynx Cancer: About 61 Cases

Extensional imaging of laryngeal tumors relies on multi-bar helical CT scans. This examination requires compliance with a few simple rules in its preparation and performance. The protocol for performing cervico-mediastinal CT scans will be developed. Imaging must take into account not only the initial tumor pathology, but also the entire upper aero-digestive tract and lymph node areas, i.e. acquisition must extend from the base of the skull to the cervico-mediastinal orifice. Thoracic imaging should be performed as a matter of course for overall patient management. Certain deep extensions, only accessible by imaging, are decisive in the choice of treatment: surgery or radio-chemotherapy. In the case of surgery, imaging is a key factor in the choice of total or partial surgery. A complete lymph node survey is also essential in the management of these lymphophilic tumors.

Modeling NK-cell lymphoma in mice reveals its cell-of-origin and microenvironmental changes and identifies therapeutic targets

Extranodal NK/T-cell lymphoma (ENKTCL) is an Epstein-Barr virus (EBV)-related neoplasm preferentially involving the upper aerodigestive tract. Here we show that NK-cell-specific Trp53 disruption in mice leads to the development of NK-cell lymphomas after long latency, which involve not only the hematopoietic system but also the salivary glands. Before tumor onset, Trp53 knockout causes extensive gene expression changes, resulting in immature NK-cell expansion, exclusively in the salivary glands. Both human and murine NK-cell lymphomas express tissue-resident markers, suggesting tissue-resident NK cells as their cell-of-origin. Murine NK-cell lymphomas show recurrent Myc amplifications and upregulation of MYC target gene signatures. EBV-encoded latent membrane protein 1 expression accelerates NK-cell lymphomagenesis and causes diverse microenvironmental changes, particularly myeloid propagation, through interferon-γ signaling. In turn, myeloid cells support tumor cells via CXCL16-CXCR6 signaling and its inhibition is effective against NK-cell tumors in vivo. Remarkably, KLRG1-expressing cells expand in the tumor and are capable of repopulating tumors in secondary recipients. Furthermore, targeting KLRG1 alone or combined with MYC inhibition using an eIF4 inhibitor is effective against NK-cell tumors. Therefore, our observations provide insights into the pathogenesis and highlight potential therapeutic targets, including CXCL16, KLRG1, and MYC, in ENKTCL, which can help improve its diagnostic and therapeutic strategies.

Changing rates of synchronous upper aerodigestive tract malignancy in head and neck cancer- why are we still using panendoscopy?

Changing rates of synchronous upper aerodigestive tract malignancy in head and neck cancer- why are we still using panendoscopy?

Advances in laryngopharyngeal reflux: Etiology, diagnosis, and management.

Laryngopharyngeal reflux (LPR) manifests as a variety of nonspecific upper aerodigestive tract symptoms. Rather than a single disorder, LPR may be conceived of as a spectrum of subtypes with varying clinical presentations. LPR signs and symptoms arise from the direct and/or indirect effects of refluxate, physical and molecular injury of the mucosa, and neurologic responses to esophageal events. Specific constituents of refluxate exert distinct mucosal responses and immediate or delayed effects resulting in transient or persistent symptoms and/or laryngeal hypersensitivity. While the complex etiology of LPR presents challenges to its diagnosis and management, tools that aid the identification of LPR subtypes can provide insight into treatment decision-making. Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring provides detailed analysis of reflux events, enabling the development of individualized treatment plans, yet cost and availability limit its widespread use. Alginates offer temporary symptom relief and antireflux surgery may provide benefit when symptoms are recalcitrant to other approaches. Pepsin inhibitors hold promise as a medical therapy when surgery is not an option. Laryngeal hypersensitivity should be considered as part of a comprehensive therapeutic approach. Promising medical and scientific research continues to yield new insights into the complex etiology of LPR and novel strategies for its diagnosis and management.

Quality of life in disease-free survived patients with early-stage extranodal nasal-type NK/T-cell lymphoma after definitive intensity-modulated radiotherapy: a cross-sectional study of 310 cases

PurposeRadiotherapy is a critical treatment for early-stage extranodal nasal-type NK/T-cell lymphoma (ENKTL) and has yielded favorable survival outcomes. However, their postradiotherapy quality of life (QOL) has not been investigated. Here, we conducted a cross-sectional study to assess the QOL of ENKTL patients with disease-free survival after definitive radiotherapy and to identify factors associated with QOL and treatment optimization.MethodsThis cross-sectional study included 310 patients with stage I–II ENKTL of the upper aerodigestive tract (UADT) who had received simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with a consistent design and achieved disease-free survival. The median postradiotherapy time was 47.2 months (range, 3.1–115.7). The EORTC QLQ-H&N35 questionnaire was used to assess symptom-related QOL, and nine additional items were added to incorporate nasal, optical, and aural-related symptoms. The scores indicate the severity of the symptoms.ResultsThe most common postradiotherapy symptoms among patients with ENKTL were nose problems (49.7%), dry mouth (44.8%), tooth problems (41.3%), sensory problems (32.6%), and less sexuality (25.8%). Tooth problems had the highest average score of 18.6, which is still acceptable. The severity of these symptoms decreased over time and reached a plateau in the second year after radiotherapy. Multivariable regression analysis showed that whole-neck irradiation was an independent predictive factor for xerostomia (P = 0.013, OR = 1.114), while age > 60 years was a predictive factor for lower sexuality (P < 0.001, OR = 1.32).ConclusionThe QOL of patients with early-stage ENKTL after radiotherapy was favorable, and most symptoms improved over time. Radiotherapy was correlated with specific symptoms, which may suggest a direction for further improvement in SIB-IMRT.

Development of Machine Learning Copilot to Assist Novices in Learning Flexible Laryngoscopy.

Here we describe the development and pilot testing of the first artificial intelligence (AI) software "copilot" to help train novices to competently perform flexible fiberoptic laryngoscopy (FFL) on a mannikin and improve their uptake of FFL skills. Supervised machine learning was used to develop an image classifier model, dubbed the "anatomical region classifier," responsible for predicting the location of camera in the upper aerodigestive tract and an object detection model, dubbed the "anatomical structure detector," responsible for locating and identifying key anatomical structures in images. Training data were collected by performing FFL on an AirSim Combo Bronchi X mannikin (United Kingdom, TruCorp Ltd) using an Ambu aScope 4 RhinoLaryngo Slim connected to an Ambu® aView™ 2 Advance Displaying Unit (Ballerup, Ambu A/S). Medical students were prospectively recruited to try the FFL copilot and rate its ease of use and self-rate their skills with and without the copilot. This model classified anatomical regions with an overall accuracy of 91.9% on the validation set and 80.1% on the test set. The model detected anatomical structures with overall mean average precision of 0.642. Through various optimizations, we were able to run the AI copilot at approximately 28 frames per second (FPS), which is imperceptible from real time and nearly matches the video frame rate of 30 FPS. Sixty-four novice medical students were recruited for feedback on the copilot. Although 90.9% strongly agreed/agreed that the AI copilot was easy to use, their self-rating of FFL skills following use of the copilot were overall equivocal to their self-rating without the copilot. The AI copilot tracked successful capture of diagnosable views of key anatomical structures effectively guiding users through FFL to ensure all anatomical structures are sufficiently captured. This tool has the potential to assist novices in efficiently gaining competence in FFL. NA Laryngoscope, 2024.

Patients-Reported Outcomes of Acute Side Effects During Head and Neck Cancer Radiotherapy: A Cross-Sectional Study at Andalas University Hospital Padang

Background: Head and neck cancer is a malignancy originating from the upper aerodigestive tract. Head and neck cancer patients undergoing radiotherapy using brachytherapy, 2DRT, 3CDRT, and IMRT techniques. Patients undergoing radiotherapy will experience several acute side effects consisting of mucositis, dysphagia, xerostomia, and dermatitis. This is influenced by the technique and dose given. This study aims to grade and time the acute side effects of radiotherapy for head and neck cancer at the Andalas University Hospital Padang. Methods: A quantitative descriptive method with a cross-sectional approach is used. Secondary data with a total sample of 88 patients. This research uses medical record data and is analyzed using statistical analysis methods. Results: This study found that the most head and neck cancer patients who underwent radiotherapy were male 57 (64.8%) patients, nasopharyngeal subsite 41 (46.6%) patients with non-keratinizing nasopharyngeal carcinoma 32 (36.4%) patients. The most common radiotherapy technique for head and neck cancer was IMRT in 58 (65.9%) patients with a dose of 61-70 Gy in 78 (88.6%) patients and the most common stage was IV A in 51 (58%) patients. Patients did not undergo chemotherapy treatment in 51 (58%) and surgery in 69 (78.4%). Body mass index (BMI) before radiotherapy was normal in 74 (84.1%) patients and after radiotherapy became underweight in 57 (64.8%) patients resulting in weight loss 1 kg in 83 (94.3%) patients. The highest grade of radiotherapy side effects was grade 1 which consisted of mucositis 84 (95.5%), dysphagia 83 (94.3%), xerostomia 78 (88.6%), and dermatitis 78 (88.6%) patients. The most frequent timing of mucositis side effects occurred in the 3rd week in 40 (45%) patients, dysphagia in the 3rd week in 41 (47%) patients, xerostomia in the 3rd week in 33 (38%) patients, and dermatitis at week 6 in 24 (27%) patients. Conclusions: Patients with head and neck cancer who undergo radiotherapy from week 1 to week 7 will experience side effects, including mucositis, dysphagia, xerostomia, and dermatitis. The average side effect appears in the 3rd week with grade 1.

Oral cavity squamous cell carcinoma complicated by internal jugular vein thrombosis

Head and neck squamous cell carcinoma (SCC) encompasses various cancers from the upper aerodigestive tract. Initial presentation often includes regional nodal involvement (40% in stage IVA or B) and distant metastases (up to 10%). Facial edema is a frequent clinical issue with multiple causes, such as allergic reactions, trauma, venous thrombosis, infections, and both benign and malignant conditions. An extremely rare condition is tumor thrombosis of the internal jugular vein (IJV), typically reported in differentiated thyroid cancer cases. We present a diagnosed case of SCC of the left lower alveolus in a 54-year-old female who presented with diffuse facial swelling and stridor two years post-diagnosis. Further evaluation through clinical examination and imaging studies revealed partial thrombosis of the right IJV. The patient underwent an emergency tracheostomy and was treated with intravenous heparin, which effectively managed the local symptoms. This case report highlights the clinical features, diagnostic methods, treatment modalities, and favorable prognosis associated with the long-term effects of untreated head and neck cancers.

Investigation of photothermal treatment with 532nm laser light on laryngeal cancer in an in vivo tumor model.

Laryngeal cancer is the second most common cancer in the upper aerodigestive tract,with its incidence increasing across all ages. The conventional treatments for laryngeal cancerinclude surgical procedure, radiation, and chemotherapy; however, these treatments can leadto various complications. Photothermal therapy (PTT) using laser light has been employed formcancer effective treatment because of its minimal invasion and short operation time. Thecurrent study aims to investigate the feasibility of 532 nm PTT on laryngeal cancer in an invivo tumor model.Ex vivo dosimetry evaluation was conducted to determine the laser irradiationconditions, and HEP-2 tumor bearing mice were used to demonstrate in vivo photothermaleffects. In addition, histology and western blot analysis were conducted to verify tumornecrosis and any changes in cancer-associated factors in the tumor tissues.The current in vivo results showed that PTT at 5 W for 40 s and 20 W for 10 s hadcomparable effects in terms of temperature increase and tumor removal. The 532 nm PTTsignificantly decreased the remaining tumor and downregulated the expression levels of MMP-9 and ERK.The current study demonstrated that the 532 nm PTT could be a feasible optionfor treatment of laryngeal tumor with high power delivery for a short exposure time. Furtherinvestigations will confirm the endoscopic application of the 532 nm PTT for the treatment ofintralaryngeal tissue prior to clinical translation.

Oropharyngeal Lipoma: A Rare Case of Dysphagia.

Lipomas are benign and slow-growing neoplasms that typically develop in the subcutaneous tissue. They rarely occur in the upper aerodigestive tract. Oropharyngeal lipomas are rare. They represent 0.5% of all neoplasms of the head and neck. We present a case of a 43-year-old female with a polypoid mass in the base of the left palatine tonsil. The patient underwent a left tonsillectomy and a resection of the mass. The pathological diagnosis was tonsillar lipoma. We describe the clinical characteristics and the management of this rare case. Palatine tonsillar lipoma is a rare benign tumor with an unusual recurrence rate, and an excellent prognosis.

Role of reflux symptom index score in diagnosis of laryngopharyngeal reflux

Background: The retrograde flow of gastric contents to the upper aero digestive tract is known as laryngo pharyngeal reflux disease (LPRD). Diet and lifestyle play a huge role in the pathophysiology of LPR. Methods: A hospital based cross sectional study in the Department of ENT, KMCT, Kozhikode. 291 Patients were selected from those who presented to the OPD with throat symptoms who scored &gt;10 in a questionnaire (Reflux symptom Index) that was provided and were advised to undergo video laryngoscopy and their reflux finding score (RSI)was calculated. LPRD prevalence, RSI/Reflux Findings Score (RFS) correlations, and clinical/ laryngoscopic (video laryngoscopy) associations were analyzed. Results: LPRD prevalence was 68.7%, higher in females (60.1%) and the 41-50 age group (31.3%). Increased spicy food/caffeine intake and shorter dinner-bedtime intervals were significantly associated. Heartburn/indigestion was the most common symptom, with RSI mean 12.94±2.26. Erythema/hyperaemia was the most frequent laryngeal finding, with RFS mean 8.47±2.40. RSI and RFS scores significantly correlated. Conclusions: This study demonstrates a high LPRD prevalence among patients with throat symptoms, particularly in females aged 41-50 and influenced by dietary/lifestyle factors. RSI effectively identified LPRD in this resource-constrained setting, highlighting its diagnostic value. These findings provide valuable insights for managing and further investigating LPRD.

Mesenchymal Tumors of the Head and Neck.

The majority of neoplasms of the head and neck are of epithelial origin primarily including mucosal squamous cell neoplasms (papillomas; squamous cell carcinoma) as well as salivary gland neoplasms. However, the full spectrum of mesenchymal neoplasms (benign and malignant) typically arising in soft tissue sites may also develop in superficial layers of the upper aerodigestive tract. The diversity of mesenchymal neoplasms arising in the head and neck is beyond the scope of this article, and our focus will be on some of the more common and/or diagnostic problematic mesenchymal tumors occurring in the sinonasal tract, oral cavity/odontogenic, pharynx, larynx, and neck.

199. YOUNGER AGE AS AN INDEPENDENT FACTOR FOR SUBSEQUENT HEAD AND NECK CANCER AFTER CURATIVE ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Post-operative survival of esophageal cancer patients has improved with advances in technology and treatment modalities. However, squamous cell carcinoma often affects the esophagus together with the head and neck regions, with second primary head and neck cancer (SPHNC) adversely influencing the patients’ quality of life. Therefore, patients with esophageal squamous cell carcinoma (ESCC) should be carefully followed up post-operatively. This study evaluated the risk of developing SPHNCs after an esophagectomy for ESCC. Methods Patients with ESCC who underwent curative esophagectomy from January 2008 to December 2017 from two tertiary medical centers, Taipei Veteran General Hospital and Kaohsiung Veteran General Hospital, were retrospectively reviewed. SPHNC development was documented according to anatomic region and the cumulative incidence rate and risk factors were analyzed. Results The median observation time of the 435 patients included in our study was 48.5 months [interquartile range (IQR) 16.7–92.4 months]. Among the ESCC patients after curative esophagectomy, younger age &amp;lt;50 [hazard ratio (HR) 4.13, 95% CI: 2.53–6.75, p &amp;lt; 0.001) was the only independent factor for developing SPHNCs in the multivariable analysis. The cumulative incidence rate of SPHNCs of patients aged &amp;lt; 50 years old was 14.3%, 22.1%, and 34.2% after 3, 5, and 10 years, respectively. Conclusion There was a high risk of secondary cancer after ESCC in the upper aerodigestive tract, especially the head and neck regions, therefore active surveillance is strongly recommended, especially in younger patients.

Tracheostomy Avoidance in Flap Reconstruction of the Upper Aerodigestive Tract is Safe in Selected Patients.

Assess the impact of tracheostomy on postoperative morbidity and mortality and examine factors that predicted tracheostomy in head and neck flap patients. Retrospective cohort January 2017 to December 2021. Single tertiary center. Adult patients undergoing head and neck flap reconstruction were included, excluding cutaneous reconstruction, laryngectomy, or with tracheostomy present at surgery. Patients were routinely extubated immediately following surgery. Univariate and multivariable analyses examined associations between tracheostomy and postoperative outcomes and identified predictors of tracheostomy. We included 193 patients, 69 (35.8%) with tracheostomy and 124 (64.2%) without. Tracheostomy avoidance was associated with no difference in 30-day mortality (P = .531) and with decreased likelihood of 30-day complications (0.019), unplanned return to the operating room (0.021), and discharge to a facility (<0.001) and with 2.2 decrease in length of stay on multivariable analysis (confidence interval [CI]: 0.62-3.82, P = .007). Four patients (2.1%) required reactive tracheostomy with no resulting mortalities. Significant associations with tracheostomy on multivariable analysis included bilateral neck dissections (odds ratio [OR]: 3.13, CI 1.12-9.06, P = .030), number of resected mandibular subsites (OR: 2.65, CI: 1.50-5.67, P = .0023), specimen volume (OR: 1.87, CI: 1.29-2.71, P = .001), body mass index < 20 (OR: 3.80, CI: 1.24-11.64, P = .019), mandibulectomy (OR: 0.04, CI: 0.01-0.22, P < .001), forearm flap (OR: 0.15, CI: 0.05-0.41, P < .001), oral cavity site (OR: 0.21, CI: 0.06-0.73, P = .014), and age > 70 (OR: 0.33, CI: 0.14-0.81, P = .016). Tracheostomy avoidance is safe in properly selected patients undergoing head and neck flap reconstruction. Multiple factors predicted tracheostomy, which may guide patient selection at other centers.