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Burgess C et al. - A 72-year-old man was referred to the Department of Neurosurgery at the John Radcliffe Hospital for surgical management of dysphagia, the underlying cause of which had eluded diagnosis for almost 10 years. A provisional diagnosis of mild neuromuscular incoordination of the pharynx was made. A videofluoroscopic swallow examination demonstrated a delayed and inconsistent cough reflex, evidence of silent aspiration, and pooling of secretions in the valleculae and piriform sinuses.

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