This retrospective study was conducted: (1) to establish the incidence of dysphagia with head injury, (2) to demonstrate the capabilities of videofluorography (VFG) in identifying the common areas of swallowing dysfunction, and (3) to demonstrate the dysphagia management advantages of the VFG. Nine patients (30%) were found to have significant swallowing problems among 30 patients admitted to the Head Injury Program, Erie County Medical Center, Buffalo, NY in 9 months. These nine patients represent 4-5% of all head-injured patients admitted. The most common swallowing problems demonstrated by videofluorography barium swallow were prolonged oral transit and delayed swallowing reflex; each occurring in 87-5% of eight cases. The study revealed a high correlation between swallowing dysfunction and prolonged hospitalization. Serial VFGs document improved swallowing function, and indicate when relatively safe cessation of nasogastric tube feedings can be achieved. This may permit shorter hospitalization.