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Review
. 2015 Jan;204(1):49-58.
doi: 10.2214/AJR.13.12374.

Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors

Nasir M Jaffer  1 , Edmund Ng, Frederick Wing-Fai Au, Catriona M Steele
Affiliations
Review

Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors

Nasir M Jaffer et al. AJR Am J Roentgenol. 2015 Jan.

Abstract

Objective: The purposes of this article are to review the anatomy of the upper gastrointestinal tract; review techniques and contrast agents used in the fluoroscopic examination of the oropharynx and hypopharynx; provide a pictorial review of some important causes of oropharyngeal dysphagia; and link these causes to key findings in the clinical history to assist in establishing a clinical diagnosis.

Conclusion: Many important causes and presentations of oropharyngeal dysphagia are sometimes overlooked during conventional upper gastrointestinal studies. Videofluoroscopic evaluation for assessment of both structural abnormalities and motility disorders of the oropharynx by use of various compositions of barium contrast medium is the standard of practice. Using best-practices radiographic techniques and having knowledge of swallowing mechanisms and various diseases are important for assessment of dysphagia. Dynamic fluoroscopic imaging remains an essential tool for assessing functional disorders of swallowing. Detailed videofluoroscopic assessment can guide treatment decisions with the goal of decreasing the secondary complications of dysphagia.

Keywords: fluoroscopy; oropharyngeal dysphagia.

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Figures

FIGURE 1
FIGURE 1
Radiologic anatomy of the oropharynx.
FIGURE 2
FIGURE 2
Functional anatomy of the phases of swallowing.
FIGURE 2
FIGURE 2
Functional anatomy of the phases of swallowing.
FIGURE 3
FIGURE 3
Development of a progressively worsening cricopharyngeal bar over time.
FIGURE 4
FIGURE 4
Lateral view of cervical esophagus, demonstrating a focal ring-like web in the cervical esophagus.
FIGURE 5
FIGURE 5
Different views of a Zenker’s diverticulum, extending inferiorly and compressing the cervical esophagus.
FIGURE 6
FIGURE 6
Antero-posterior and lateral views in a patient with a left lateral Killian-Jamieson Diverticulum.
FIGURE 7
FIGURE 7
Antero-posterior view showing an enlarged right lobe of the thyroid causing compression and lateral displacement of the cervical esophagus.
FIGURE 8
FIGURE 8
Lateral view showing anterior osteophytes in the region of C 4, 5 and 6 causing narrowing of the cervical esophagus
FIGURE 9
FIGURE 9
A left posterior oblique view showing a leak and fistula from left lateral aspect of the cervical esophagus in a patient with laryngectomy.
FIGURE 10
FIGURE 10
Antero-posterior and lateral views showing complete obstruction in the cervical esophagus at the C4/C5 level 2 years after laryngectomy and radiation therapy for laryngeal carcinoma. Note the post radiation mucosal web in the hypopharynx.
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