HEAD AND NECK RECONSTRUCTION: Edited by Arnaud F. BewleyCurrent opinions in otolaryngology and head and neck surgery: functional considerations in reconstruction after laryngectomyElson, Nora C.b; Martinez, Daniel C.a; Cervenka, Brian P.aAuthor Information aDepartment of Otolaryngology Head and Neck Surgery bCollege of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Correspondence to Brian P. Cervenka, MD, Department of Otolaryngology Head and Neck Surgery, College of Medicine, University of Cincinnati, Medical Sciences Building, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA. Tel: +1 513 558 7024; fax: +1 513 558 4477; e-mail: firstname.lastname@example.org Current Opinion in Otolaryngology & Head and Neck Surgery: October 2020 - Volume 28 - Issue 5 - p 355-364 doi: 10.1097/MOO.0000000000000645 Buy Metrics Abstract Purpose of review To review reconstruction techniques following total laryngectomy, partial laryngopharyngectomy, and total laryngopharyngectomy with an emphasis on long-term swallow and speech outcomes. Recent findings Recent literature has shown that the use of fasciocutaneous free flaps in the reconstruction of laryngectomy defects may lead to improved speech and swallow outcomes as compared with regional or free musculocutaneous flaps. Radial forearm and anterolateral thigh are the most often used fasciocutaneous free flaps, with similar speech and swallow outcomes. Primary closure with myofascial flap onlay yields similar speech and swallow results to fasciocutaneous flaps following laryngectomy that spares sufficient pharyngeal mucosa. Summary Whenever reconstructing a salvage laryngectomy defect or a primary laryngectomy defect with mucosal deficiency, current evidence suggests that a fasciocutaneous free flap used to augment pharyngeal volume both improves fistula rates as well as long-term speech and swallow outcomes. When sufficient pharyngeal mucosa is present, myofascial onlay can be considered as well. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.