Causes of Oropharyngeal Dysphagia

Oropharyngeal dysphagia has typical signs and symptoms of nasal regurgitation and laryngeal aspiration during process of swallowing. These typical signs and symptoms are generally due to pharyngeal stasis of food. In case of oropharyngeal dysphagia there is poor control and formation of food bolus and as a result food drools out of mouth or food overstay in mouth. Sometimes there may be difficulty in initiating a swallow. Poor control of food bolus leads to spillage of food into the pharynx which may result in aspiration into the larynx (which is unguarded) and/or regurgitation into nasal cavity. Aspiration and/or regurgitation occur during pharyngeal phase of swallowing, which is usually de to poor pharyngeal propulsion and obstruction at the upper esophageal sphincter.

What are the causes of oropharyngeal dysphagia?

There are various causes of oropharyngeal dysphagia, such as mechanical (tumor in head and neck, developmental abnormalities etc.), motor disorders, radiation therapy, inflammation etc.

Oropharyngeal dysphagia due to mechanical causes:

  1. Defect in the wall due to congenital defect cleft lip, cleft palate etc. or defect after surgery.
  2. Stricture or narrowing of food passage due to congenital abnormality (congenital microganthia), ingestion of alkali or acid or may be due to radiation (e.g. radiotherapy of a tumor/cancer). Narrowing may also be due to tumors (which may be benign or malignant). Narrowing may also be due to inflammation e.g. infection by bacteria (abscess), virus (herpes simplex, varicella-zoster, cytomegalovirus etc.), fungus (candida), or injury (thermal or chemical injury).
  3. External compression may also lead to oropharyngeal dysphagia. External compression may be due to any mass, abscess in pharynx, Zenker’s diverticulum, thyroid problem or disorder in a bone.

Oropharyngeal dysphagia due to motor causes:

  1. Diseases of brainstem or cerebral cortex: dementia (e.g. Alzheimer’s disease), encephalopathy, encephalitis, meningitis, cerebrovascular accident, brain injury, altered consciousness, cerebral palsy, diseases (e.g. rabies, tetanus, poliomyelitis, post-poliomyelitis syndrome, Parkinson’s disease, Multiple sclerosis, motor neuron disease, neurosyphilis) etc.
  2. Neuromascular diseases such as myasthenia gravis, botulism, drugs such as aminoglycosides.
  3. Diseases of cranial nerves involving the nerves V, VII, IX, X, XII: nerve injury, neuropathies such as Guillain-Barré syndrome, sarcoid, diabetic complications.
  4. Disorders of musclessuch as polymyositis, dermatomyositis, sarcoidosis, thyroid myopathy, myotonic dystrophy, oculopharyngeal myopathy etc.

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