Objective: The purpose of this study is to determine the utility of radiographic swallow study following a total laryngectomy or total laryngopharyngectomy when evaluating for presence of pharyngocutaneous fistula. Methods: We performed a retrospective analysis of patients undergoing total laryngectomy and total laryngopharyngectomy at University of Maryland Medical Center between the years of 2009-2014. Patients underwent closure of surgical defect by a variety of methods including primary closure, regional muscle flap, and vascularized soft tissue transfer. The results of the swallow study were identified as being either positive or negative for a fistula. Medical records were reviewed to determine whether or not each patient went on to develop a clinically evident salivary leak. Results: Totally 48 patients were selected for inclusion into the study based on the presence of a swallow study performed at either 1 week, 2 weeks, or 3 weeks post-operatively. Sensitivity and positive predictive value (PPV) were optimized at 1 week, while specificity and negative predictive value (NPV) were optimized at 3 weeks. There was no significant difference between salivary leak rates in radiated versus non-radiated patients or with the various methods of closure. Overall sensitivity of swallow study was found to be 50.0%, specificity was 92.1%. PPV and NPV were 62.5% and 87.5% respectively. Conclusion:The utility of contrasted swallow studies is limited due to its poor sensitivity, independent of timing. High risk patients may benefit from an extended period of NPO (nil per os; "nothing by mouth") status, foregoing a contrasted study. Standardization of study protocols and randomized prospective trials will better investigate these issues.