Risk factors predicting aspiration after free flap reconstruction of oral cavity and oropharyngeal defects.
OBJECTIVE
To determine risk factors predicting early postoperative aspiration in patients after microvascular free flap reconstruction of oral cavity and oropharyngeal defects.


METHODS
Retrospective analysis.


METHODS
Academic tertiary care referral medical center.


METHODS
The study included 100 patients who underwent resection of oral cavity or oropharyngeal tumors with immediate free flap reconstruction of the defect.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Smith
Jesse E
JE
Division of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, USA.
Suh
Jeffrey D
JD
Erman
Andrew
A
Nabili
Vishad
V
Chhetri
Dinesh K
DK
Blackwell
Keith E
KE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000564:Ameloblastoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D053120:Respiratory Aspiration / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps