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Fig. 4. —67-year-old man who underwent replacement of mitral valve, transesophageal echocardiography, and long-term intubation. Videofluoroscopic image obtained in lateral plane shows nearly no tilting of epiglottis (large arrowhead). Note intradeglutitive aspiration of contrast material into trachea (arrow) and narrowing of pharyngeal cavity (small arrowheads) caused by pharyngeal constrictors during swallowing.