Dysphagia is difficulty swallowing, a condition often underdiagnosed. Recent attention has been given to its accurate evaluation and treatment. Swallowing involves the pharynx, divided into the nasopharynx, oropharynx, and hypopharynx. The pharynx is supported by skeletal structures and includes muscles like the facial, tongue, palatal, suprahyoid, and pharyngeal muscles. Inside the pharynx are the valleculae and pyriforms. The laryngeal valves include the epiglottis, aryepiglottic folds, false vocal cords, and true vocal cords. Most palatal and pharyngeal muscles are innervated by the tenth cranial nerve. Sensation is provided by the ninth cranial nerve and the superior laryngeal branch of the tenth cranial nerve. Cortical control is in the anterolateral cortex, with fibers descending to the substantia nigra and mesencephalic reticular formation. The brainstem swallowing center is in the medulla. The pharyngoesophageal sphincter (PES) is a high-pressure zone between the pharynx and esophagus, preventing air and reflux. The PES is closed at rest and opens through three processes: inhibition of intrinsic muscles, contraction of suprahyaoid muscles, and distension by bolus pressure. Swallowing is divided into three phases: oral, pharyngeal, and esophageal. The oral phase involves moving the bolus posteriorly and sealing it with the lips and buccal muscles. The pharyngeal phase begins when the bolus passes the anterior tonsil pillars and ends when it passes through the PES into the esophagus. During this phase, the soft palate closes the nasopharynx, and the bolus is propelled through the pharynx. The laryngeal valves close, and the PES opens, creating negative pressure. The esophageal phase begins when the bolus enters the esophagus and ends when it passes through the lower esophageal sphincter into the stomach. Peristaltic waves propel the bolus. Abnormalities in swallowing can occur in any phase, but the oral and pharyngeal phases are discussed. Oral phase dysfunction may result in anterior leakage or malpositioning of the bolus. Weakness in oral muscles or decreased sensation can lead to improper bolus positioning. Tongue dysfunction may cause tethering or decreased movement, leading to difficulty in initiating the pharyngeal phase.Dysphagia is difficulty swallowing, a condition often underdiagnosed. Recent attention has been given to its accurate evaluation and treatment. Swallowing involves the pharynx, divided into the nasopharynx, oropharynx, and hypopharynx. The pharynx is supported by skeletal structures and includes muscles like the facial, tongue, palatal, suprahyoid, and pharyngeal muscles. Inside the pharynx are the valleculae and pyriforms. The laryngeal valves include the epiglottis, aryepiglottic folds, false vocal cords, and true vocal cords. Most palatal and pharyngeal muscles are innervated by the tenth cranial nerve. Sensation is provided by the ninth cranial nerve and the superior laryngeal branch of the tenth cranial nerve. Cortical control is in the anterolateral cortex, with fibers descending to the substantia nigra and mesencephalic reticular formation. The brainstem swallowing center is in the medulla. The pharyngoesophageal sphincter (PES) is a high-pressure zone between the pharynx and esophagus, preventing air and reflux. The PES is closed at rest and opens through three processes: inhibition of intrinsic muscles, contraction of suprahyaoid muscles, and distension by bolus pressure. Swallowing is divided into three phases: oral, pharyngeal, and esophageal. The oral phase involves moving the bolus posteriorly and sealing it with the lips and buccal muscles. The pharyngeal phase begins when the bolus passes the anterior tonsil pillars and ends when it passes through the PES into the esophagus. During this phase, the soft palate closes the nasopharynx, and the bolus is propelled through the pharynx. The laryngeal valves close, and the PES opens, creating negative pressure. The esophageal phase begins when the bolus enters the esophagus and ends when it passes through the lower esophageal sphincter into the stomach. Peristaltic waves propel the bolus. Abnormalities in swallowing can occur in any phase, but the oral and pharyngeal phases are discussed. Oral phase dysfunction may result in anterior leakage or malpositioning of the bolus. Weakness in oral muscles or decreased sensation can lead to improper bolus positioning. Tongue dysfunction may cause tethering or decreased movement, leading to difficulty in initiating the pharyngeal phase.