1.2 Intro & Anatomy Flashcards by Jamie Bevill

What is dysphagia?

The inability to swallow

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What is a bolus?

a food ball

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What is laryngeal penetration?

Anything entering the larynx

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What is aspiration?

when it goes below the level of the vocal folds

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What is residue?

food that is left in the vocal tract after we complete a swallow. The type of residue tells about the anatomy structure.

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What kind of function is swallowing?

a neuro-motor function like speech production

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What accompanying disorder do children and adults with neuro-motor speech disorders have?

a swallowing disorder

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Speech-production and swallowing involve what anatomical structures?

The same

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Who else works with patients with swallowing disorders?

Otolaryngologist
Gastroenterologist
Radiologist
Neurologist
Respiratory therapist
Occupational therapist
Dietician
Dentist
Nurse
Neurodevelopmental specialist
Patient’s family

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When is an inpatient acute setting utilized?

When a patient first has the event, such as a stroke, and goes to the hospital

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When is an inpatient sub-acute setting utilized?

Where a patient goes after acute or when prognosis gets better

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When is an inpatient rehabilitation setting utilized?

Where a patient goes after they are stable but unable to be left alone

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What is an outpatient clinic setting?

It is like what we have at ECU

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When is an home health setting utilized?

When a patient gets to go home and a SLP goes to their house to provide therapy

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What structures are involved in the Oral stage?

1 + 8

Oral Cavity:

Lips
Jaw
Tongue
Hard palate
Soft palate
Cheek
Mandible
Maxilla.

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What structures are involved in the Pharyngeal stage?

Base of the tongue

Soft palate

Larynx (hyoid bone, epiglottis, laryngeal vestibule, true and false vocal folds, ary-epiglottic folds)

Cricopharyngeus.

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What structures are involved in the Esophageal stage?

Esophagus

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What muscle opens up the UES?

Cricopharyngeus

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What are the four muscles of mastication

Masseter

Temporalis

Medial pterygoid

Lateral pterygoids

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What nerve innervates the muscles of mastication?

The trigeminal nerve

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What are the important cranial nerves for speech?

Trigeminal (V)
Facial nerve (XII)
Glossopharyngeal (IX)
Vagus (X)
Hypoglossal (XI)

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What is the most important muscle of mastication?

Lateral pterygoid

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What is affected when the trigeminal nerve is damaged?

Mastication

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What is an important muscle for lip closure?

Orbicularis oris

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When does anterior spillage happen?

It happens when there isn't complete closure of the orbicularis oris (Food spills out the front of the mouth )

What is posterior spillage?

When food prematurally spills out at the back of the mouth

What muscles are important to know about the lips? | 5

- Levator labii superioris - Zygomaticus Major - Zygomaticus Minor - Depressor anguli oris - Depressor Labii inferioris .

What is the risorius muscle responsible for?

It is responsible for stretching out the sides of the mouth for smiling

How is the facial nerve involved with the tongue?

It senses taste in the anterior 2/3 of tongue

What does the tensor veli palatini muscle do?

Tenses the palate (adds the bulk)

What does the levator veli palatini muscles do?

Elevates the palate

What does the palatopharyngeus muscle do? | 2

Closes the nasopharynx Pull the pharynx upward behind the bolus of food (and nearly come together)

What does the palatoglossus muscle do? | 2

It raises back of tongue to connect with the palate Narrows fauces (assuming to make sure bolus is small enough to swallow)

What does the uvula do?

Triggers the gag reflex

What nerve controls all of the muscles of the palate except for the tensor veli palatini?

Vagus nerve

What nerve innervates the tensor veli palatini?

Trigeminal nerve

What are the four supra-hyoid muscles?

Geniohyoid Digastric Mylohyoid Stylohyoid

What is the most important suprahyoid muscle for the superior and anterior movements?

Geniohyoid

What three supra-hyoid muscles are involved in superior movement?

Digastric Mylohyoid Stylohyoid

What is the stylohyoid muscle innervated by?

Facial nerve

What is the geniohyoid muscle innervated by?

Hypoglossal nerve

What nerve innervates the mylohyoid and digastic?

Trigeminal nerve

What is the anterior movement of the larynx important for?

Protection

What is the superior movement of the larynx important for?

Opening up the UES

What are the extrinsic muscles of the tongue? | 4

Palatoglossus Styloglossus Hyoglossus Genioglossus

What is the Oral Preparatory Phase?

Preparing the food or liquid into a bolus

What does the Oral Preparatory Phase require? | 1+5

Requires coordination of... - Lips - Tongue - Teeth - Mandible - Cheeks

What happens in the oral phase?

Bolus is propelled to the back of the mouth (oropharynx)

What is the duration of the oral phase?

duration: 1 to 1.5 sec

What are the steps of the pharyngeal phase? | 7

- Velopharyngeal closure - Tongue base retracts to posterior pharyngeal wall - Closure of the epiglottis - Hyoid elevation and laryngeal vestibule squeeze - Approximation of the true and false vocal folds - Pharyngeal stripping - Opening of the UES .

What does the oral prep phase require? What is it negatively affected by? (3)

Intact dentition // Poor salivary function Surgical defects Neurological disorders.

What is triggered when food enters the mouth?

Sensory receptors (taste, smell, pressure, temperature).

How does oral hygiene factor into aspiration? | 2

Individuals with bad oral hygiene are more likely to develop pneumonia due to aspiration. Having good oral hygiene decreases the change of developing pneumonia due to aspiration.

Which glands produce saliva? | 3

Parotid Sub-mandibular Sub-lingual

What is important about the parotid gland?

It is the largest but doesn't produce the most saliva

What are the two types of saliva?

Thin watery (serum-like) or thick (mucous like)

Why is saliva important? | 3

Oral hygiene Keeping micro-organisms away Bolus formation

What does the sub-mandibular gland produce?

Produces a combination of thin and thick liquid (responsible for 60 to 70%)

What does the sub-lingual glands produce?

It only produces thick saliva

What do you need to have a good saliva production?

Good oral hygiene

What is the clinical term for dry mouth?

Xerostomia

What nerve controls taste | sensation for the anterior 2/3rd of tongue and general sensation hard palate, and soft palate?

Facial Nerve

What nerve controls Oral Sensation for the posterior 1/3rd of tongue?

Glossopharyngeal Nerve

How does oral sensation travel to the sensory cortex? | 4

Oral/pharyngeal areas -> Nucleus Tractus-Solitarius -> Thalamus -> Sensory cortex

In regards to the oral phase, what does the mastication muscles do? (2)

Form the bolus Bolus is placed on the tongue blade

What is the second step of the oral phase? | 2

Tip of the tongue is elevated and backward Motion of the bolus into the oro-pharynx is initiated.

What is the third step of the oral phase? | 2

Extrinsic tongue muscles and palatal muscles work to push bolus posteriorly Nasopharynx is sealed

What is the forth step of the oral phase?

Sensory receptors in the posterior parts of the tongue and palate guide the initiation of pharyngeal swallowing.

What sequential activation happens during the start pharyngeal phase?

Sequential activation of superior, middle and inferior constrictor muscles

What is the 2nd step of the pharyngeal phase?

Contraction of the posterior portions of the tongue Forward movement of Lower Pharyngeal Wall (LPW) and Posterior Pharyngeal Wall (PPW).

What is the 3rd step of the pharyngeal phase? What contributes to it?

Pharyngeal stripping, Flow-pressure dynamics (movement from high pressure zones to low pressure zones)

What is the 4th step of the pharyngeal phase?

Simultaneous activation of supra-hyoid muscles to move the hyoid bone upward and forward.

What is the 5th step of the pharyngeal phase? What happens during it? (2)

Closure of the larynx // Epiglottic inversion Laryngeal squeeze

What is the last step of the pharyngeal phase?

Food reaches the level of Upper-esophageal segment.

During the esophageal phase, what is triggered as the bolus enters the UES?

Peristalsis | wave-like muscle contractions that moves food

Is there only one peristalsis?

There is a primary peristalsis and secondary peristalsis for every bolus

During the esophageal phase, What propels the bolus to the LES?

Alternate ring like contractions

During the esophageal phase, what happens if food is not cleared away by a primary peristalsis?

A secondary peristalsis happens to move boluses residue

How is the esophageal phase assessed?

Manometry (this is not a part of our field)

What is the white out period during a videoscopy?

This is when the screen goes white because everything squeezes.

What is swallowing apnea? When does it happen?

Momentary cessation of breathing during a swallow It occurs when the vestibule is being squeezed

What is pharyngeal stripping?

???

When hypoglossal is impaired, what stage of swallowing will be most affected? (2)

Oral Prep Oral Stage

What muscles are used in pharyngeal stripping?

Pharyngeal Constrictors

How is the Internal Branch of SLN involved in swallowing? What happens when it is impaired? (2)

Sensation within larynx // Loss of ability to sense when to cough Silent aspiration