Main Article Highlights

• Radiation-induced dropped head syndrome (DHS) and dysphagia may emerge decades after treatment. This case describes progressive symptoms developing 17 years after radiotherapy for Hodgkin lymphoma, emphasizing the need for lifelong vigilance in cancer survivors.

• First comprehensive description of coexisting DHS and dysphagia after radiotherapy. The report proposes that swallowing impairment results from the combined effects of radiation-induced neuromuscular injury and mechanical alterations in cervical posture.

• Multidisciplinary assessment is essential. Diagnosis required integration of neurological examination, electromyography, cervical MRI, videofluoroscopic swallowing study (VFSS), laryngoscopy, and speech-language pathology evaluation.

• Head position directly influenced swallowing efficiency. VFSS demonstrated substantial pharyngeal residue without aspiration, with improved bolus clearance when the patient's head was manually supported in a more physiological position.

• Radiation-induced dysphagia is not solely a swallowing muscle disorder. Cervical muscle atrophy, postural deformity, and degenerative cervical spine changes may significantly contribute to impaired swallowing mechanics.

• Rehabilitation improved patient-reported outcomes. A structured program of physiotherapy, swallowing therapy, dietary modification, compensatory strategies, and cervical stabilization improved swallowing-related quality of life despite minimal objective electrophysiologic change.

• Swallowing assessment should become routine in long-term follow-up. The authors recommend incorporating dysphagia screening and formal swallowing evaluation into survivorship care for patients treated with head and neck radiotherapy, particularly those who develop neck extensor weakness or postural abnormalities.

• Clinical message: New-onset dysphagia in long-term cancer survivors should prompt evaluation for delayed radiation-induced neuromuscular complications, even decades after successful cancer treatment.