Week 1 Flashcards
The Anatomy and Stages of Swallowing
What is Dysphagia? and that does Dysphagia involve
Dysphagia is disorder or difficulty with swallowing. • Dysphagia involves disruption of any one or more of the stages of swallowing: Oral, Pharyngeal
and Oesophageal
what is dysphagia not?
It is not a disease or primary medical diagnosis itself, rather a symptom of an underlying disease process.
What does swallowing involve?
Swallowing is an extremely complex process that involves input and coordination from at least 26 pairs of muscles & 6 cranial nerves.
what are the 5 stages of the swallow?
- Oral Anticipatory
- Oral Preparation
- Oral Transit
- Pharyngeal stage
- Oesophageal stage
what swallowing stages are under voluntary control ?
The oral stage (Anticipatory+ Preparation + Transit) is under voluntary control i.e. it can be interrupted at any time
what swallowing stages are NOT under voluntary control ?
The pharyngeal & oesophageal stages are involuntary.
What is the primary role of the Anticipatory (Pre- Oral) Stage?
Pre-oral motor, cognitive, psychosocial, & somatoesthetic elements.
what happens in the Anticipatory (Pre- Oral) Stage?
Sensory acknowledgement that food is present leads to an appropriate or expected response (e.g. mouth opening, judging how much to put in your mouth, using smell, judging temperature).
What is the primary role of the Oral Preparatory Stage?
Preparation of food and fluid for oral transit & initiation of the pharyngeal swallow.
how long is the duration of the Oral Preparatory Stage?
As the oral preparatory stage is under voluntary control, its duration varies according to a range of factors (e.g. sensory, cognitive, emotive).
what are the first 6 steps of the Oral Preparatory Stage?
- The mouth & lips open to accept the bolus.
- The tongue forms a ‘groove’ to accept the bolus.
- The lips seal around the bolus to prevent anterior spillage of the bolus (1st of 4 valves; part of the pressure system).
- Tension in the lips & cheeks keeps the food in the correct Place.
- Food & liquid in the mouth stimulates taste, temperature, & pressure (touch) receptors.
- Saliva is produced by as the salivary glands are
activated.
What happens to Solids in the Oral Preparatory Stage?
Coordinated action of the tongue & jaw moves the bolus onto the teeth for mastication (rotatory chewing to grind & crush the bolus by the teeth).
what are the two oral control actions with solids in the Oral Preparatory Stage?
- Buccinator press: cheek tension flattens the cheeks & keeps the bolus within the “dental vault”.
- Contact of tongue & hard palate stops food tipping into pharynx- glossopalatal seal
What happens to solids during mastication in the Oral Preparatory Stage
The bolus is mixed with saliva this helps to form a moist cohesive bolus of appropriate size & consistency for swallowing. The tongue manipulates, shapes, holds & transfers the bolus into the oropharynx. Some of the bolus is allowed to collect in the valleculae.
what happens to liquids in the Oral Preparatory Stage
Lip seal & cheek tone help control & manipulate the liquid bolus & prevent anterior spillage from front (or corners) of the mouth
what is the Glossopalatal seal and why is it important in the Oral Preparatory Stage
tongue & soft palate contact seals the back of the oral cavity, containing the bolus within the mouth and prevents premature spillage into the pharynx (glossopalatal seal) before the swallow is triggered. more important for liquids than solids.
what is the key (8) anatomy of the Oral Preparatory Stage?
- Lips
- Cheeks
- Tongue
- Hard / soft palate
- Jaw
- Teeth
- Salivary glands
- Taste bud
What is the primary role of the Oral Transit Stage
Posterior propulsion of the bolus from the oral cavity into the pharynx following bolus preparation.
what are the first 5 steps of the Oral Transit Stage?
- Tongue tip elevates & presses against the hard palate occluding the oral cavity.
2. Tongue dorsum & cheek tension contain the bolus laterally.
3. Posterior tongue drops to open the back of the oral cavity.
4. Tongue-palate contact expands rom front to back – squeezing the bolus back along the palate & into the oropharynx, through the faucial arches.
5. The pharyngeal stage or reflexive swallow is triggered.