Pediatric Severe Oropharyngeal Dysphagia: A Clinical Challenge Addressed Through a Novel Approach.

We present the case of a 2-year-old male with persistent oropharyngeal dysphagia and recurrent aspiration. Feeding difficulties began in the neonatal period, characterized by coughing, wet cry, choking, and cyanosis during feeds. Multiple hospitalizations followed, and flexible endoscopic evaluation of swallowing (FEES) showed mobile vocal folds and pharyngeal pooling and silent aspiration with various consistencies, alongside absent swallow initiation. Videofluoroscopic swallowing studies (VFSS) demonstrated ongoing penetration and aspiration, with contrast coating both, anterior and posterior tracheal wall during pharyngeal phase, leading to gastrostomy placement. What mechanisms might explain persistent severe dysphagia in this child, and what therapeutic strategies could be considered?