| Summary: | Abstract Objectives How reconstruction affects function following total laryngectomy is unclear. This study seeks to determine whether reconstruction method is associated with differences in swallowing outcomes. Methods Retrospective review of reconstruction technique in patients undergoing TL was compared by pharyngeal transit time (PTT), patient‐reported dysphagia (EAT‐10), and diet‐tolerated (FOIS). Results Ninety‐five patients met inclusion criteria, with 40 patients (42.1%) undergoing primary closure and 55 patients (57.9%) undergoing tissue transfer. There was no difference in EAT‐10 scores between the groups (P = .09). There was a significantly higher proportion of patients achieving oral diet (FOIS >3) with primary closure (P = .003). Patients undergoing PMC vs free flap had similar rates of g‐tube dependency. Primary closure had the shortest PTT (1.89 seconds) compared to free flap (3.47‐4.65 seconds) or PMC (5.1 seconds; P = .035). Conclusions When primary closure is achievable, these results suggest improved swallowing outcomes with better tolerance of oral diet and shorter pharyngeal transit times. Level of evidence IV
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