Oral dysphagia. An unique symptom for a wide spectrum of diseases

Dysphagia, defined as a difficulty in swallowing of fluids and/or solid foods, is one of the most frequent symptoms of esophageal, gastrointestinal, ear, nose and throat diseases. As such, it poses a diagnostic challenge and an interdisciplinary clinical problem. Of particular importance in diagnosis is to distinguish between esophageal and oropharyngeal dysphagia. Oropharyngeal dysphagia is often associated with neuromuscular disorders and is treated with rehabilitative protocols, while esophageal dysphagia may be due to anatomical alterations and esophageal motility difficulties. While the former can be adequately treated with endoscopic or surgical therapy, the latter are currently treated only pharmacologically. Interestingly, dysphagia may present as the initial symptom of a wide spectrum of oral conditions, including traumatic ulcerations, neuromuscular diseases, systemic and local immuno-mediated or infectious lesions, malignant neoplastic diseases or mucositis following chemo-radiotherapy for head and neck cancers: in these cases it is called oral dysphagia. Dysphagia, with or without evident oral lesions, suggests the presence of an oropharyngeal disease and requires adequate diagnostic-therapeutic management. This paper describes the major oral and systemic diseases that may manifest themselves with oral manifestations inducing dysphagia. Clinical management guidelines in dysphagia triggered by neuromyogenic pathogenesis are discussed.