This composite educational clinical figure illustrates oropharyngeal and esophageal pathologies contributing to dysphagia. Image (a) is a transoral endoscopic view of an 87-year-old patient showcasing post-surgical changes following an extended partial resection of the right oropharynx and neck dissection. Visible features include a disrupted pharyngeal wall structure on the right and distorted mucosa consistent with radiotherapy and chemotherapy effects. Image (b) presents a transnasal endoscopic view of the velum and posterior oropharyngeal wall. It demonstrates significant scarring and asymmetrical contraction of the right-sided velum, with visible scar tissue extending across the posterior pharyngeal wall. Prominent white, viscous saliva is seen spanning the lumen, indicating impaired clearance and a transportation disorder. Image (c) is a contrast radiography (barium swallow) from a different patient, identifying tissue formations (indicated by an arrow) in the pharynx or esophagus that create mechanical obstacles. Together, these images teach how oncological treatments, scarring, and structural abnormalities disrupt the swallowing mechanism.

This composite figure illustrates a comparative evaluation of oropharyngeal dysphagia before and after treatment for cricopharyngeal (CP) muscle dysfunction. Panels A and B are Fiberoptic Endoscopic Evaluation of Swallowing (FEES) stills. Panel A (Pre-treatment) shows massive green-dyed mucilage secretions and pooling in the postcricoid region, indicating penetration and impaired clearance. Panel B (Post-treatment) shows a significant reduction in pharyngeal residue and clearer visualization of the laryngeal inlet. Panels C and D are lateral Video Fluoroscopic Swallowing Study (VFSS) frames. Panel C (Pre-treatment) demonstrates limited epiglottic folding and a persistent posterior indentation at the level of the CP muscle, signifying non-relaxation during a swallow attempt. Panel D (Post-treatment) reveals improved CP muscle opening, successful bolus passage through the upper esophageal sphincter, and decreased residue in the vallecula and pyriform sinuses. The images collectively demonstrate the therapeutic efficacy of botulinum toxin injection in improving upper esophageal sphincter dynamics and reducing aspiration risk in patients with neurogenic dysphagia.

A lateral view videofluoroscopic swallowing study (VFSS) image demonstrating oropharyngeal dysphagia. The image captures the cervical spine and the pharyngeal/esophageal soft tissue structures during the transit of a radiopaque contrast bolus. A prominent anterior osteophyte at the C5 vertebral body level (indicated by a black arrow) causes focal extrinsic compression and narrowing of the proximal cervical esophagus. This mechanical obstruction leads to the stasis and pooling of the contrast material above the upper esophageal sphincter. Significantly, contrast is seen misdirected into the laryngeal vestibule and trachea (indicated by a red arrow), confirming laryngeal penetration and tracheal aspiration. This diagnostic image illustrates the clinical relationship between cervical spondylosis (DISH or severe osteophytosis) and mechanical dysphagia, highlighting the risk of respiratory complications due to impaired bolus clearance and subsequent airway entry.

This diagnostic image consists of three lateral-view cervical esophagrams (fluoroscopic barium swallow study) demonstrating oropharyngeal dysphagia and mechanical obstruction. The first panel highlights prevertebral soft tissue swelling at the C3–C4 level (white circle), which causes extrinsic compression and anterior displacement of the esophagus. The subsequent panels illustrate functional swallowing impairment: radiopaque contrast material is seen abnormally pooling within the laryngeal vestibule and epiglottic space. White arrows indicate laryngeal penetration and aspiration, where contrast moves anteriorly into the airway rather than proceeding through the upper esophageal sphincter. These findings are clinically significant for diagnosing mechanical dysphagia, in this case secondary to an anteriorly extruded cervical disc. Key educational concepts include the radiographic identification of aspiration, the assessment of prevertebral soft tissue thickness, and the recognition of extrinsic esophageal compression in the context of cervical spine pathology.