Dysphagia / Delayed swallow reflex (1 of 3)
Panoramic view of laryngopharynx before administering blue-stained applesauce.

Dysphagia / Delayed swallow reflex (2 of 3)
Same view after first bolus of blue-stained applesauce. The vallecula fills with material before the swallow “happens”—signifying a delayed swallow reflex.

Dysphagia / Delayed swallow reflex (3 of 3)
After several rapidly-administered boluses (to assess patient’s “limits”), note hypopharyngeal pooling, but none within the laryngeal vestibule.

Hypopharynx pooling after swallow (1 of 1)
Shows trace of blue-stained applesauce remaining behind after the patient has swallowed.

Cricopharyngeal dysfunction: before myotomy (1 of 2)
Lateral x-ray of the neck while swallowing barium (seen as a dark column). The non-relaxing cricopharyngeus muscle (light-grey bulge outlined by a dotted line) is causing narrowing of the upper esophageal passageway, as highlighted by the narrowed stream of dark barium at that point (arrow). Liquids and very soft foods can squeak through this narrow opening, but solid foods tend to get stuck.

Cricopharyngeal dysfunction: after myotomy, resolved (2 of 2)
After myotomy. The surgically divided muscle can no longer narrow the upper esophageal passageway, as seen by the widened stream of dark barium at the level of the muscle (arrows).

Cricopharyngeal dysfunction: before myotomy (1 of 2)
Lateral x-ray of the neck while swallowing barium (the dark material seen here in the throat). The non-relaxing cricopharyngeus muscle (light-grey bulge outlined by a dotted line) is causing narrowing of the upper esophageal passageway, as highlighted by the narrowed stream of dark barium at that point (arrow). Liquids and very soft foods can squeak through this narrow opening, but solid foods tend to get stuck.

Cricopharyngeal dysfunction: after myotomy, resolved (1 of 2)
After myotomy. The surgically divided muscle can no longer narrow the upper esophageal passageway, as seen by the widened stream of dark barium at the level of the muscle (arrows).

Dysphagia, due to tongue weakness (1 of 4)
Left tongue paralysis and atrophy (the left side is right of image), due to injury of the left hypoglossal nerve during neck surgery elsewhere. The tongue and its midline raphe (arrows) deviate to the atrophied side. This atrophied side of the tongue cannot “do its part” in the propulsive stage of swallowing.

Dysphagia, due to tongue weakness (2 of 4)
Hypopharyngeal pooling of saliva in the “swallowing crescent.” This pooling can suggest non-relaxation of the cricopharyngeus muscle as an additional swallowing impediment, though in this case a videofluoroscopic swallowing study does not confirm this hypothesis.

Dysphagia, due to tongue weakness (3 of 4)
After administration of blue-stained applesauce, the same hypopharyngeal pooling is seen, now of now-blue-stained saliva.

Dysphagia, due to tongue weakness (4 of 4)
This closer view within the larynx shows not only soiling of the laryngeal vestibule with saliva bubbles, but also a left contact granuloma (right of image). This injury could be the result of intubation four months earlier, or else of the continual coughing and throat clearing that occurs with this patient's swallowing disorder.