L2: Anatomy and Physiology of Deglutition

Question 1

2 functions of swallowing

Answer 1

supportive = transports ingested material from mouth to stomach

protective = protects resp sys from entry of foreign material

Question 2

why is the swallow necessary?

Answer 2

in the adult human the upper resp and digestive paths are crossed

crossroads is called the “upper aerodigestive tract”

propulsion and protection

Question 3

goal of the digestive sys

Answer 3

obtain nutrients to support energy need, growth and cell repair

Question 4

5 parts to digestion

Answer 4

ingestion = brought into the body

propulsion = moved along the digestive tract

digestion = mechanical and chemical

absorption = nutrients pass into blood steam

defecation = waste is removed from the body

Question 5

goal of resp sys

Answer 5

gas exchange to supply oxygen-rich blood to active cells and remove CO2

Question 6

what are the two was resp can be interupted

Answer 6

foreign materials in airway block ventilatory pathways or disruption to gas exhcnage (fluid)

Question 7

what is the mechanism of protection to foreign materials entering the resp sys?

Answer 7

swallow, cough, mucocilliary clearance, lymphatics, and phagocytosis

Question 8

describe the anatomy of deglutition

Answer 8

oral cavity, pharynx, and esophagus (and stomach)

… series of expanding and contracting chambers (or tubes) bounded by muscular sphincters or valves (nasal cavity, larynx)

Question 9

bolus moves because of…

Answer 9

pos pressure behind the bolus, and a vaccum or neg pressure developed in front of the bolus

pos pressure advances the bolus through the alimentary tract (the “pumps”)

neg pressure ahead of the bolus, pulls it forward into the next alimentary chamber

Question 10

3 chambers

Answer 10

oral
pharyngeal
esophageal

Question 11

3 muscular sphincters

Answer 11

anterior oral seal (lips)

retro-oral seal

UES

Question 12

4 valves

Answer 12

linguapalatal (retro-oral seal)

velopharyngeal

laryngeal (supraglottic and glottic)

PE valve (aka UES+)

Question 13

describe what occurs in the oral chamber (bolus preparation and containment) - 4 parts

Answer 13

anterior seal by perioral muscles (muscular sphincter)

lingual shaping, FOM, muscles of mastication

sensory perception of bolus ‘readiness’

linguapalatal valve is closed for liquids, but is open during mastication of solids

Question 14

the pharyngeal chamber switches from

Answer 14

resp to deglutitory chamber by altering chamber shape and configuration of valves

Question 15

during breathing what valves are closed or open?

Answer 15

linguapalatal valve may be open or closed

velopharyngeal valve is open

laryngeal valves are open

pharyngoesophageal valve is closed

Question 16

during deglutition what valves are closed or open?

Answer 16

linguapalatal valve opens
velopharyngeal valve closes
laryngeal valves close
pharyngoesophageal opens

Question 17

describe the changes in the pharyngeal chamber during deglutition

Answer 17

first expands as tongue base and hyolaryngeal complex move forward

then, pharyngeal chamber is obliterated (shortens and constricts)

Question 18

in the esophageal chamber 2 things occur during deglutition…

Answer 18

sequential contraction of circular and longitudinal muscles (pos pressure)

LES relaxation = allows bolus to flow into stomach (neg pressure)

Question 19

4 phases of swallowing

Answer 19

oral prep

oral (transport)

pharyngeal

esophageal

Question 20

describe the oral prep phase

Answer 20

ingested material is broken down mechanically and chemically; forming a bolus

a voluntary phase - actions vary w the properties of the food/liquid; can be interrupted

Question 21

describe oral (transport) phase

Answer 21

bolus is moved posteriorly over the tongue surface into the pharynx

Question 22

describe pharyngeal phase

Answer 22

phase is triggered when a moving bolus excites oropharyngeal sensory receptors
(resp ceases aka apnea, bolus transported from mouth to eso)

involuntary = patterned motor response

Question 23

describe esophageal phase

Answer 23

bolus is transported to stomach

Question 24

oral prep phase includes (3)

Answer 24

ingestion
bolus formation
bolus containment

Question 25

oral (transport) includes (3)

Answer 25

posterior transport tongue loading elicitation of pharyngeal swallow

Question 26

pharyngeal phase includes (7)

Answer 26

velopharyngeal seal BOT propulsion laryngeal closure HLAE epi deflection UES opening pharyngeal stripping wave

Question 27

esophageal phase includes (1)

Answer 27

peristalsis

Question 28

during oral prep ingestion what structures are involved

Answer 28

lips, cheeks, mandible, tongue, teeth

Question 29

during oral prep ingestion, the lips involve what muscle and CN?

Answer 29

orbicularis oris Facial VII

Question 30

during oral prep ingestion, the cheeks involve what muscle and CN?

Answer 30

buccinator VII facial

Question 31

during oral prep ingestion, the mandible involve what muscle and CN?

Answer 31

jaw depressors and elevators V trigeminal

Question 32

during oral prep ingestion, the tongue involve what muscle and CN?

Answer 32

intrinsic and extrinsic muscles XII hypo and X vagus

Question 33

oral prep bolus formation involves what structures

Answer 33

mandible teeth tongue cheeks salivary glands

Question 34

during oral prep bolus formation, the mandible involves what muscle and CN?

Answer 34

suprahyoid and muscles of mastication V trigeminal

Question 35

during oral prep bolus formation, the tongue involve what muscle and CN?

Answer 35

intrinsic muscles XII hypo

Question 36

during oral prep bolus formation, the cheeks involve what muscle and CN?

Answer 36

buccinator VII facial

Question 37

during oral prep bolus formation, the salivary glands involve what CN?

Answer 37

VII facial and IX glossophayngeal

Question 38

oral prep bolus containment involves what 4 structures

Answer 38

tongue hard palate teeth soft palate

Question 39

during oral prep bolus containment, the tongue involves what muscle and CN?

Answer 39

instrinsic muscles genioglossus hyoglossus styloglossus palatoglossus XII hypo

Question 40

during oral prep bolus containment, the soft palate involves what muscle and CN?

Answer 40

palatoglossus palatopharyngeus X Vagus

Question 41

oral phase posterior transport involves what 3 structures

Answer 41

tongue hard palate floor of mouth

Question 42

during oral posterior transport, the tongue involves what muscle and CN?

Answer 42

intrinstic muscles genioglossus XII hypo

Question 43

during oral posterior transport, the floor of mouth involves what muscle and CN?

Answer 43

suprahyoid muscles (submental muscles specifically) V trigeminal

Question 44

oral phase tongue loadings involves what 2 structures

Answer 44

tongue and soft palate

Question 45

during oral tongue loading, the tongue involves what muscle and CN?

Answer 45

intrinsic muscles, genioglossus, hyoglossus (posterior tongue depression) XII hypo

Question 46

during oral tongue loading, the soft palate involves what muscle and CN?

Answer 46

levator veli palatini; [tensor veli palatini; musculus uvulae] X Vagus V trigeminal

Question 47

oral phase elicitation of pharyngeal phase involves what 3 structures

Answer 47

soft palate anterior and posterior faucial pillars lateral and posterior walls of pharynx

Question 48

during oral elicitation of pharyngeal phase, the soft palate involves what CN?

Answer 48

X vagus

Question 49

during oral elicitation of pharyngeal phase, the a/p faucial pillars involves what CN?

Answer 49

X vagus and IX glosso

Question 50

during oral elicitation of pharyngeal phase, the lateral and posterior walls of the pharynx involves what CN?

Answer 50

X vagus and IX glosso

Question 51

______ may be the most effective oropharyngeal site for triggering the pharyngeal swallow

Answer 51

anterior faucial arch

Question 52

what are other reflexogenic sites other than anterior faucial arch? (4)

Answer 52

soft palate posterior pharyngeal wall posterior tongue posterior faucial pillars

Question 53

pharyngeal phase velopharyngeal seal involves what 2 structures

Answer 53

soft palate posterior (and lateral) wall of pharynx

Question 54

during pharyngeal phase velopharyngeal seal, the soft palate involves what muscles and CN?

Answer 54

levator veli palatini; musculus uvulae; tensor veli palatini X vagus and V trigeminal

Question 55

during pharyngeal phase velopharyngeal seal, the posterior wall of pharynx involves what muscles and CN?

Answer 55

superior pharyngeal constrictor X vagus

Question 56

the pharyngeal phase tongue base retraction involves what 2 structures

Answer 56

tongue base mandible

Question 57

during pharyngeal phase tongue base retraction, the tongue base involves what muscles and CN?

Answer 57

styloglossus and hyoglossus XII hypo

Question 58

during pharyngeal phase tongue base retraction, the mandible involves what muscles and CN?

Answer 58

masseter and temporalis V trigeminal

Question 59

the pharyngeal phase laryngeal closure involves what 4 structures

Answer 59

true vocal folds false vocal folds arytenoids epiglottis

Question 60

during pharyngeal phase laryngeal closure, the true vocal folds involve what muscles and CN?

Answer 60

thyroarytenoids; lateral cricoarytenoids; interarytenoids X vagus RLN

Question 61

during pharyngeal phase laryngeal closure, the false vocal folds involve what muscles and CN?

Answer 61

thyroarytenoids: ventricularis X vagus RLN

Question 62

during pharyngeal phase laryngeal closure, the arynteoids involve what muscles and CN?

Answer 62

thyroarytenoids X Vagus RLN

Question 63

during pharyngeal phase laryngeal closure, the epiglottis involves what muscles and CN?

Answer 63

thyroepiglotticus; aryepiglotticus X vagus RLN

Question 64

the pharyngeal phase hyolaryngeal anterior excursion involves what 2 structures

Answer 64

hyoid bone thyroid cartilage

Question 65

during pharyngeal phase hyolaryngeal anterior excursion, the hyoid bone involves what muscles and CN?

Answer 65

geniohyoid; mylohyoid; anterior belly of digastric; posterior belly of digastric; stylohyoid C1 by XIi hypo V trigeminal VII facial

Question 66

during pharyngeal phase hyolaryngeal anterior excursion, the thyroid cartilage involves what muscles and CN?

Answer 66

thyrohyoud and stylopharyngeus ansa cervicalis; X vagus

Question 67

pharyngeal phase epiglottic defection (retroversion) involves what structure and 2 movements?

Answer 67

epiglottis to horizontal, epiglottis full retroversion

Question 68

during pharyngeal phase epiglottic defection, the epiglottis to horizontal involves what muscles?

Answer 68

muscles acting on HL complex

Question 69

during pharyngeal phase epiglottic defection, the epiglottis to full retroversion involves what muscles and CN?

Answer 69

aryepiglotticus and thyroepiglotticus (X vagus) pharyngeal constrictors, muscles of tongue base retraction (X vagus and XII hypo)

Question 70

describe the path of the bolus near the larynx

Answer 70

bolus flows lateral to the larynx w/i the pyriform sinuses 1 pyriform sinus on each side bw larynx and pharyngeal wall

Question 71

pharyngeal phase opening of UES involves what 2 structures

Answer 71

pharyngoesophageal segment/UES hyolaryngeal complex

Question 72

during pharyngeal phase opening of UES, the pharyngoesophageal segment/UES involves what muscles and CN?

Answer 72

cricopharyngeus X vagus

Question 73

during pharyngeal phase opening of UES, the hyolaryngeal complex involves what muscles and CN?

Answer 73

suprahyoid m V trigeminal; C1

Question 74

what are the 4 steps that allow for the opening of the UES

Answer 74

Relaxation of the cricopharyngeus muscle tissue compliance of the UES traction from movement of the hyolaryngeal complex intrabolus pressure

Question 75

pharyngeal phase pharyngeal stripping wave involves what structure

Answer 75

pharynx

Question 76

during pharyngeal phase pharyngeal stripping wave, the pharynx involves what muscles and CN?

Answer 76

constrictor muscles and elevator muscles X vagus

Question 77

esophageal phase peristalsis involves what structure

Answer 77

esophagus

Question 78

during esophageal phase peristalsis, the esophagus involves what muscles and CN?

Answer 78

outer longitudinal; inner circular m X vagus

Question 79

body of the esophagus is relaxed in _____; UES and LES are normally _____, relaxing on _____

Answer 79

basal state contracted demand

Question 80

what are the 4 contractile properties of esophagus?

Answer 80

peristalsis = progressive, normal/constant amplitude, non repetitive, non spon = motility primary peristalsis = distally progressive wave initiated by the act of swallowing secondary peristalsis = distally progressive wave initiated by esophageal distension other motor events: tertiary contraction = non peristaltic contraction of the body of the esophagus