Chapter 8: Physiology of Mastication and Deglutition Flashcards
mastication
act of chewing
deglutition
umbrella term for the entire process of swallowing (includes all the phases)
bolus
lump of food after you’ve prepared it that’s about to be swallowed
stages of deglutition
oral preparatory phase, oral transit phase, pharyngeal phase, esophageal phase
oral preparatory phase
purpose - to prepare the bolus for swallowing
processes - both voluntary and involuntary
parts of the process:
- hunger/motivation to eat
- delivering food to mouth
- taking a bite (opening the lips/jaw)
- maintaining oral closure to prevent food from coming out
- velum valve against base of tongue; thus, nasal breathing
- chewing/grinding - vertical and lateral jaw movement
- forming the bolus - tongue movement (mixes with saliva)
- cheek muscles work with tongue to keep food on occlusal surfaces of teeth for continued grinding
oral transport phase
purpose - to move the bolus to the oropharynx
processes - both voluntary and involuntary
- tongue base drops, velum elevates to prevent nasal regurgitation
- apex and dorsum pushes up against hard palate and moves in a front to back rolling movement to squeeze bolus back to oropharynx
pharyngeal phase
-what triggers it?
purpose - to propel bolus from oropharynx to esophagus (not trachea)
processes - involuntary once initiated (bolus in posterior oral cavity and faucial pillars triggers it)
- base of tongue moves forward
- pharynx squeezes
- epiglottis inverts
- bolus pools in valleculae, divides into 2 down L and R pyriform sinuses
- larynx moves up and forward -> epiglottis inverts
- vocal folds adduct
- Upper Esophageal Sphincter relaxes and opens
everything goes back to normal after bolus enters the esophagus
hyolaryngeal elevation
- so when the base of tongue moves forward lightly pulls up the hyoid
- leading complex: stylohyoid, mylohyoid, stylohyoid, middle pharyngeal constrictors
- digastricus, geniohyoid, genioglossus, thyropharyngeus
- hyoid elevation aids in epiglottic inversion
- elevation triggers the UES to relax and open
esophageal phase
-when does it begin?
-what muscle is the UES made of
purpose - to transport bolus down from the upper esophageal sphincter to the lower esophageal sphincter, stomach
processes - entirely involuntary
- begins when bolus enters UES
- UES = cricopharyngeus (inferior pharyngeal constrictor), closed at rest, hyoid elevation triggers it to open, closes again as bolus passes
- peristalsis = sequential squeezing of the esophagus from superior to inferior (w the help of gravity)
SLP role in swallowing
- we are the primary health care providers who evaluate and deal with swallowing disorders
evaluation methods
-OME: Oral mechanism exam (oral motor exam)
-bedside swallow assessment
-modified barium swallow study (videofluoroscopic swallow study)
-flexible endoscopic evaluation of swallow
DDK
diadochokinetic
oral-mechanism exam (OME)
-observe passively; look for asymmetry
-test strength of the muscles, range of motion, accuracy of movements (alternate motion rate, sequential motor rate)
-upper face: raise eyebrows, squint
-lower face/lips: show teeth (labial (DDKs)
-jaw: open close, side to side
-tongue: protrude/retract (lingual DDKs)
-soft palate: test gag, palatal DDK
clinical bedside swallow
-suspected to have swallowing disorders
-always begin with OME
-amounts and textures to swallow: puree (safer than water), honey thick, nectar thick, thin liquid, solid
-observe for symptoms of penetration: cough, check by having them phonate (if it went thru VF)
video steps:
-cognitive screen
-assess to follow one step commands
-oral motor exam
