Objective: To determine risk factors predicting early postoperative aspiration in patients after microvascular free flap reconstruction of oral cavity and oropharyngeal defects. Design: Retrospective analysis. Setting: Academic tertiary care referral medical center. Patients: The study included 100 patients who underwent resection of oral cavity or oropharyngeal tumors with immediate free flap reconstruction of the defect. Main Outcome Measures: Dysphagia severity was assessed by modified

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... 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 resec-tion; 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 Ͻ .001), tongue base resection classification (P=.001), tumor N stage (PϽ.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.