What is the pathophysiology of dysphagia in pharyngeal-phase disorders?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

If pharyngeal clearance is severely impaired, a patient may be unable to ingest sufficient amounts of food and drink to sustain life. In people without dysphasia, small amounts of food commonly are retained in the valleculae or pyriform sinus after swallowing. If there is weakness in or a lack of coordination of the pharyngeal muscles or if there is a poor opening of the upper esophageal sphincter, patients may retain excessive amounts of food in the pharynx and experience overflow aspiration after swallowing.

Dysfunction or abnormalities of the soft palate and superior pharynx (eg, cleft palate) can lead to nasopharyngeal reflux following uvulectomy.

Logemann's Manual for the Videofluorographic Study of Swallowing cites the following pharyngeal-phase swallowing symptoms and disorders [11] :

  • Delayed pharyngeal swallow

  • Nasal penetration during swallow due to reduced velopharyngeal closure

  • Pseudoepiglottis (after total laryngectomy): Fold of mucosa at the base of the tongue

  • Cervical osteophytes

  • Coating of pharyngeal walls after the swallow due to bilateral reduction of pharyngeal contraction

  • Vallecular residue due to reduced posterior movement of the tongue base

  • Coating in a depression on the pharyngeal wall due to scar tissue or pharyngeal pouch

  • Residue at top of airway due to reduced laryngeal elevation

  • Laryngeal penetration and aspiration due to reduced closure of the airway entrance (arytenoid to base of epiglottis)

  • Aspiration during swallow due to reduced laryngeal closure

  • Stasis of residue in pyriform sinuses due to reduced anterior laryngeal pressure

  • Delayed pharyngeal transit time


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