Head and neck reconstruction has shifted to increasingly utilize microvascular reconstruction as the versatility and reliability of free flaps have improved over time. However, earlier steps of the reconstructive ladder are often optimal for smaller volume defects of the oral cavity. Skin grafts, local flaps, and regional tissue transfer afford the benefit of minimal donor site morbidity and avoid the need for microvascular expertise with smaller volume defects. The panelist will review the appropriate indications for various oral cavity reconstructive defects and define the “tipping point” when a free flap may be required. In addition, the presentation will provide technique for optimal outcomes for various reconstructive surgeries including skin grafts, regional flaps, and microvascular reconstruction. This topic will be handled through a panel presentation that will include both didactic and interactive components. A brief introduction will review classifications schemas of various defects of the oral cavity based on key features of the defects (10 minutes). This will be followed by a moderated three case discussion with experts input analyzing the reconstructive subsite including the oral tongue/floor of mouth, buccal mucosa and hard palate. Discussion among the panelists regarding reconstructive options will result in a consensus statement on the “tipping point” for free flaps.