Introduction 

Typically dysphagia originates from either an obstructive or motor defecit. Occasionally, patients present with a long history of symptoms and medical investigation that serve to remind us of the need to think laterally. 

The case 

We report a case of an elderly patient who had been investigated by a number of medical specialties for a complaint of dysphagia and resultant vomiting. These symptoms had been ongoing on a daily basis for at least 10 years. Investigations had encompassed plain film chest radiographs, barium swallows, panendoscopies and MRI, all of which were unremarkable. Inheriting this patient, a repeat plain film chest radiograph and oesophago-gastro-duodenoscopy were performed which, apart from a small hiatus hernia, were unremarkable. Despite this, the patient continued to complain of a “lump” in her throat which was precipitating her symptoms. Direct visual dynamic assessment identified an elongated, hypotrophic uvula and a hyperdynamic soft palate, the consequences of which meant the uvula was frequently stimulating the gag reflex, indirectly causing dysphagic-like symptoms. This was subsequently treated with a uvulo-palatoplasty 

Discussion

 This case serves to highlight a need to consider the potential impact of functional anatomy: The gag reflex was being stimulated by repeated brushing of the uvula against the posterior pharyngeal wall. It is possible that the patient has a hypersensitive reflex, however normal uvulopalatal function would not result in such routine stimulatory contact. Given the relative lack of functional purpose of the uvula, reduction surgery is inconsequential.