In videofluoroscopic evaluation, if premature spillover and delayed initiation of the pharyngeal phase are observed, which maneuver is evaluated first?

• A. Chin tuck
• B. Turn head toward weak side
• C. Mendelsohn maneuver
• D. Tilt head toward the strong side

Answer: (A)

When premature spillover and a delayed pharyngeal trigger are present, the first maneuver to test is the chin-tuck. This posture narrows the space in the oropharynx and alters the bolus trajectory so it is directed more posteriorly, which helps the airway to be protected as swallowing is initiated. By tucking the chin toward the chest, the epiglottis can cover the laryngeal inlet more effectively and the swallow can be triggered sooner, reducing the chance that material spills into the pharynx before the swallow begins. In videofluoroscopic observation, you’d look for a reduction in premature spillage and an earlier pharyngeal swallow with this adjustment.

If the chin-tuck doesn’t provide the needed improvement, other compensatory strategies—such as turning the head toward the stronger side to redirect bolus flow, tilting the head toward the strong side, or specific maneuvers like the Mendelsohn to prolong hyolaryngeal elevation—may be explored based on the specific weaknesses observed.