[Oropharyngeal dysphagia in neuromuscular diseases--differential diagnosis, examination procedure and therapy]

After a synopsis of brain stem structures participating in swallowing, the main neurologic diseases are presented as a part of which swallowing disorders may occur: central and peripheral nervous system, motor end-plates and muscles can be involved. The sequence of clinical examination is described with special reference to findings in mouth, pharynx and larynx as well as to findings in high-frequency cinematography. After description of normal swallowing pre-, intra- and postdeglutitive mechanisms of aspiration are shown. This distinction has proved useful for practical reasons. Finally we give a survey of therapeutic possibilities reported in recent years in literature and developed in our hospital, divided into indirect (facilitation of orofacial and laryngeal voluntary muscles) and direct therapeutic strategies (strategy of compensation during feeding). In connection with this therapeutic possibilities applied during pre-, intra- and postdeglutitive phase, depending on neuromuscular disturbances, are also described.