INTRODUCTION This chapter is about difficulty swallowing due to dysfunction of the upper oesophageal sphincter or cricopharyngeus. The applied anatomy and physiology of the upper oesophageal sphincter are first described. The chapter then details the management of cricopharyngeal dysphagia, with and without a pharyngeal pouch. Management of the conditions requires consideration of medical, endoscopic and open surgical approaches. All of these are discussed.