The oblique pharyngogram: value in the assessment of dysphagia

Background: To evaluate the diagnostic value of oblique views of the pharyn x in patients with dysphagia. Methods: One hundred thirty-three patients with symptoms referable to the c ervical region underwent pharyngoesophography that included views of the ph aryngoesophageal junction filmed at three frames per second and spot films of the pharynx obtained in distended frontal, lateral, and both oblique pro jections. Examination was completed with assessment of the entire esophagus and gastric cardia. Results: The oblique views identified abnormalities not shown on the standa rd views in 5% of patients. The oblique views proved useful in 12%, where t he 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 o cciput and mandible in the frontal projection. In 12%, the oblique views pr oved useful in demonstrating normal structures when artifacts raised the po ssibility of lesions on the standard projections. In 10%, poor technique im paired visualization of pharyngeal structures on the standard projections, but repeat swallows in the oblique projections proved adequate to assess th ese regions. Three (27%) of the 11 cases of cervical esophageal webs were b est seen on oblique views, and in another three patients the webs were visi ble only on oblique views. Conclusions: Oblique views are of value in the assessment of the pharynx. T here will be instances when the standard projections are inadequate, and th ese alternative views will complement the evaluation of this region. The ad dition of oblique views will sometimes improve the confidence of the interp retation of normality or assist evaluation of the extent of an abnormality.