 Dispature due to problems in oral phase can occur in paralysis of 5th nerve, 7th nerve or 12th nerve because there will be problem in bolus formation itself since an adequate size of bolus should form for entry into the esophagus. Problems in pharyngeal phase can occur because of paralysis of 9th and 10th nerve because these are the ones which are carrying the impulses from the oropharynx and also bringing about the constriction of various muscles in the pharynx but you see the oropharyngeal dysphagia is usually accompanied by other symptoms of paralysis of these nerves. So in oropharyngeal dysphagia if their problem is on oral phase so bolus formation is difficult and it can also lead to drooling there may be problem with occlusion of the jaw so it will lead to drooling of saliva in pharyngeal there may be nasal regurgitation because we have seen that there will be closure of the nasopharynx in this phase there may be cuffing repeated cuffing after food because the food will enter into the air passages now esophageal dysphagia may occur either due to narrowing of the lumen of esophagus that is the structural problems in the esophagus or it may be due to motor problems that means the coordinated wave of peristalsis initial contraction and relaxation of the muscle is not taking properly now when there is narrowing of the esophagus mostly it leads to dysphagia with solid foods but the motor problems the movement problems it leads to dysphagia with both solid and liquid as we've already told that peristalsis is essential for both movement of solid and liquid narrowing the movement is normal so liquid can pass but solid will have difficulty in passing from esophagus to stomach but as narrowing progresses the lumen may become so small that even liquids may have problem of entering stomach but there may be other problems also which may be associated with soar loin now suppose this low esophageal sphincter either fails to relax that is intonically contracted more or it relaxes too often so when low esophageal sphincter fails to relax food will not be able to enter from esophagus to stomach and it will start accumulating in the esophagus so slowly slowly esophagus will increase in size and it will lead to mega esophagus so it is a condition known as a chalicia but if elias relaxes too often it will lead to reflux of contents from stomach into the esophagus so that is known as gastroesophageal reflux well this happens if there is too much volume of food in the stomach which many of you might have experienced so reflux of gastric contents occur in the esophagus or it also happens with the consumption of too much tea, coffee, alcohol, nicotine so all these things lead to too often relaxation of lower esophageal sphincter now what will happen if there is problem with this coordinated peristaltic wave so there is a condition known as diffuse esophageal spasm in this condition contractions are not followed by relaxation instead there are multiple points of contractions so which is not happening in normal peristalsis so this type of esophagus is known as corkscrew esophagus so there is diffuse esophageal spasm and if we measure the pressures inside the esophagus so what we do is insert multiple sensors which go at multiple points in the esophagus so one sensor will be here other sensor will be here next sensor may come here we'll see that at various points there is increased pressure wherever there is contraction there will be increased pressure which is not happening in case of normal peristalsis now next we know that the initial one-third portion of esophagus is striated muscle skeletal muscle that means myopathies affecting skeletal muscles disorders affecting neuromuscular junctions like myocinic rabbit's can also cause dysphagia