The oblique pharyngogram: value in the assessment of dysphagia

To evaluate the diagnostic value of oblique views of the pharynx in patients with dysphagia.

One hundred thirty-three patients with symptoms referable to the cervical region underwent pharyngoesophography that included views of the pharyngoesophageal junction filmed at three frames per second and spot films of the pharynx obtained in distended frontal, lateral, and both oblique projections. Examination was completed with assessment of the entire esophagus and gastric cardia.

The oblique views identified abnormalities not shown on the standard views in 5% of patients. The oblique views proved useful in 12%, where the lower pharynx was obscured in the lateral projection by large shoulders, and in 18% to assess the valleculae when this region was obscured by the occiput and mandible in the frontal projection. In 12%, the oblique views proved useful in demonstrating normal structures when artifacts raised the possibility of lesions on the standard projections. In 10%, poor technique impaired visualization of pharyngeal structures on the standard projections, but repeat swallows in the oblique projections proved adequate to assess these regions. Three (27%) of the 11 cases of cervical esophageal webs were best seen on oblique views, and in another three patients the webs were visible only on oblique views.

Oblique views are of value in the assessment of the pharynx. There will be instances when the standard projections are inadequate, and these alternative views will complement the evaluation of this region. The addition of oblique views will sometimes improve the confidence of the interpretation of normality or assist evaluation of the extent of an abnormality.