Chapter 8

Question 1

Iowa Oral Pressure Instrument (IOPI)

Answer 1

Flexible ball that measures force - tongue or lips

Question 2

Electromyography

Answer 2

Measures muscle function during swallowing

Question 3

Pharyngeal manometry

Answer 3

Pressure measure

Question 4

Modified barium swallow study (MBSS

Answer 4

Videoradiographically record individual ingesting barium of various textures - anterior and lateral views
–Definitive test of oropharyngeal dysphagia

Question 5

Fiberendoscopic evaluation of swallow (FEES)

Answer 5

Detect aspiration and pharyngeal residue, can visualize structures - see tumors
–Do not have radiology exposure or consumption of barium

Question 6

Ultrasound

Answer 6

–Observe movement during swallowing but bone impedes visualization

Question 7

Mastication

Answer 7

food preparation process, including chewing food, mixing it with saliva, grinding food with the teeth
–The end-product of mastication is a bolus or a quantity of material to be swallowed

Question 8

Deglutition

Answer 8

swallowing process

Question 9

4 phases of deglutition

Answer 9

Oral preparation
–Oral transit
–Pharyngeal
–Esophageal

Question 10

Structures in deglutition

Answer 10

Deglutitive anatomy includes the structures of the oral cavity, the pharynx and larynx, as well as the esophagus

Question 11

Important oral cavity structures include:

Muscles and others

Answer 11

Labiae and labial mm
–Buccal cavity, as well as buccal mm
–Dentition
–Mandible and mandibular mm
–Palate and velar mm
–Intrinsic and extrinsic lingual mm
–Salivary glands

Question 12

Labial and buccal muscles assistance

Answer 12

Labial and buccal muscles assist in oral containment of the bolus and include the upper lip elevator mm and lower lip depressor mm
–Buccal contraction assists in keeping the food out of the lateral sulcus

Question 13

Labial and buccal muscles involved In deglutition

Answer 13

MM that are primarily involved: obicularis oris, mentalis, buccinator and risorius

Question 14

Dental contributions to mastication

Answer 14

Dental contributions to mastication include cutting, grinding and tearing
–Incisors – cut
–Cuspids – tear (meat)
–***Molars – grind

Question 15

Mandibular mm support the mastication process

Answer 15

Masseter, temporalis, medial and lateral pterygoid

Question 16

Additional anatomy involved in mastication include

Answer 16

The soft palate and posterior tongue create a seal to avoid premature spillage in adult swallowing
–Lingual muscles move food off/onto the dental grinding surfaces
–Salivary glands (3) are active and adding saliva aids in creating a cohesive bolus

Question 17

Mastication involves

Answer 17

Mastication involves labial, lingual, dental, buccal, salivary, and mandibular components of the oral cavity
–Dentition and mandibular mm provide structures and motion for the act of chewing
•Mandibular mm work in a semi-rotary fashion to support dental grinding

Question 18

Food during mastication

Answer 18

–Mastication requires that food does not spill anteriorly (i.e., a good labial seal) or posteriorly (i.e., posterior tongue and velum) or laterally (i.e., buccal mm)
–Lingual action assists in moving the food off/onto the dental grinding surfaces
–Salivary glands help in creation of a cohesive bolus

Question 19

Anatomy involved in moving the bolus

Answer 19

Anatomy involved in moving the bolus through the oral cavity towards the pharyngeal cavity include
–Lingual mm
–Velar mm
–Labial mm
–Buccal mm

Question 20

Lingual mm involvement

Answer 20

Lingual mm involvement relates to raising the bolus with the tongue tip and then moving the bolus in a posterior direction by squeezing the bolus along the palate
–Sequential activation of anterior and then posterior lingual mm
–The soft palate raises to allow continued movement through the oral cavity

Question 21

Bolus propulsion occurs secondary to

Answer 21

–Mandibular elevator mm
–Lingual mm
•Mylohyoid elevates the tongue
•Sup. Longitudinal elevates the tongue tip
•Vertical cups/grooves the tongue
•Genioglossus moves the tongue body
•Styloglossus and palatoglossus elevate the posterior tongue

Question 22

Bolus cohesion is maintained secondary to

Answer 22

Labial mm (mainly the obicularis oris)
–Buccal mm (risorius and buccinator mm)
–Saliva that has been added during preparation (parotid, sublingual, and submandibular glands)

Question 23

3 different types of salivary glands

Answer 23

parotid, sublingual, and submandibular glands

Question 24

What happens during oral transit

Answer 24

Following oral preparation, the bolus is gathered in the anterior aspect of the mouth and moved towards the posterior via a stripping motion of the tongue against the hard palate
–Additional events include:
•Persistent labial seal
•Velar elevation
•Persistent buccal mm contraction

Question 25

swallow reflex

Answer 25

The swallow reflex is triggered when the bolus reaches about the level of the anterior faucial pillars •With triggering of the swallowing reflex, various pharyngeal events begin to occur

Question 26

Important pharyngeal structures include

Answer 26

``` Epiglottis –Vallecular and pyriform spaces/sinuses –Intrinsic and extrinsic laryngeal mm –Velar mm –Pharyngeal mm ```

Question 27

Velar Deglutitive Anatomy

Answer 27

Velar elevation closes off the nasopharynx to avoid nasal regurgitation –Levator veli palatini and uvula

Question 28

Intrinsic laryngeal muscles

Answer 28

Intrinsic laryngeal muscles that help to close off the airway entrance at •The vocal folds (laryngeal adductors) •The ventricular folds

Question 29

Extrinsic laryngeal muscles (elevators)

Answer 29

help to raise and move the larynx forward •This action helps to invert the epiglottis and close off the laryngeal aditus via its connection to the hyoid (hyoepiglottic ligament)

Question 30

Pharyngeal constrictor muscles and other pharyngeal mm

Answer 30

Pharyngeal constrictor muscles and other pharyngeal mm whose contraction •Help close the velopharynx (SPC) •Raise and reduce the diameter of the pharynx •Open the upper esophageal sphincter –Base of tongue mm that work in concert with the pharyngeal constrictors

Question 31

The opening of the upper esophageal sphincter

Answer 31

The opening of the upper esophageal sphincter is related to several factors –Traction from laryngeal movement –Contraction/relaxation of the cricopharyngeus –Effects of gravity on the bolus

Question 32

Pharyngeal Phase I

Answer 32

Velo-pharyngeal closure occurs •Hyo-laryngeal excursion along with bolus pressure assist in inversion of the epiglottis •Laryngeal closure and hyo-laryngeal elevation and anterior movement occur as well as apnea to protect the airway

Question 33

Pharyngeal Phase II

Answer 33

As the bolus enters the pharynx, sequential pharnygeal mm contraction along with base of tongue mm contraction help to move the bolus in an inferior direction along with gravity •Hyo-laryngeal traction and crico-pharyngeal contraction help to open the upper esophageal sphincter •The bolus passes into the esophagus •The upper esophageal sphincter closes

Question 34

2 sphincters

Answer 34

Upper esophageal sphincter (UES) | –Lower esophageal sphincter (LES)

Question 35

Esophageal Anatomy

Answer 35

The esophagus is the anatomical tube connecting the pharynx and stomach •It is bounded by 2 sphincters –Upper esophageal sphincter (UES) –Lower esophageal sphincter (LES) •The esophagus contains smooth and striated muscle

Question 36

Esophageal phase

Answer 36

Successive contraction of esophageal mm propel the food towards the LES •LES contraction occurs, relaxing the muscle, and allows for passage of the bolus into the stomach

Question 37

Clinical Application

Answer 37

SLPs are directly involved in examination of swallow & making diagnoses of dysphagia •Examinations may be instrumental or non-instrumental, with among the most informative instrumental evaluation being MBS or VFSS or cookie swallow –MBS has long been considered the gold standard and involves fluoroscopic assessment of swallow structures/function •Another instrumental evaluation is the naso-endoscopic evaluation of the swallow (or flexible endoscopic swallow evaluation)