Pharyngeal Phase

Question 1

Is the pharyngeal phase voluntary or involuntary?

Answer 1

involuntary

Question 2

What is more important during a swallow timing and speed of muscle movement or strength

Answer 2

timing and speed of muscle movement

Question 3

T or F during swallowing, valves close off to prevent food from entering nose (velum contacts posterior pharyngeal constrictors) and airway (vocal cords close and larynx moves anteriorly)

Answer 3

True

Question 4

in infants and older children’s were is sensory sent from to initiate the swallow?

Answer 4

It is sent from the upper pharynx and vallecular areas to brain (medulla)

Question 5

Where is sensory info sent from to trigger a swallow in kids 5+?

Answer 5

it is sent from the back of mouth (primarily anterior faucial pillars) and opening to pharynx

Question 6

T or F once the reflex is triggered to swallow it is involuntary

Answer 6

True

Question 7

The base of tongue does what?

Answer 7

it retracts towards posterior pharynx to make contact with pharyngeal constrictors to squeeze the bolus down

Question 8

T or F with muscles of the base of tongue—adequate strength, there is firm and tight contact with the posterior pharynx

Answer 8

True

Question 9

What pharyngeal constrictors make up the lateral and posterior pharyngeal constrictors (3)?

Answer 9

superior
medial
inferior

Question 10

What is pharyngeal stripping?

Answer 10

bolus stripping tongue to pharynx

the top-down squeeze of the pharyngeal constrictors and the base of tongue

Question 11

posterior pharyngeal wall contracts to meet what structure during the pharyngeal swallow to squeeze the bolus down?

Answer 11

the base of tongue

Question 12

T or F the hyoid bone in infants is already so high that there is not much hyolaryngeal elevation during the swallow.

Answer 12

True

Question 13

during the swallow the hyoid bone moves anteriorly and elevates during activation of swallow

Answer 13

elevation starts to increase after 6 mos

Question 14

during the swallow when the hyoid elevates and moves anteriorly what follows?

Answer 14

the larynx

Question 15

what does hyolaryngeal excursion contribute to during the swallow?

Answer 15

it contributes to epiglottis retroflexion/inversion (flips down backwards)

Question 16

After hyolaryngeal excursion and epiglottis inverts what else happens during the pharyngeal swallow?

Answer 16

the vocal folds adduct to close

the vocal folds stay closed until after swallow then a reflexive exhalation happens when they open

Question 17

When do the vocal folds open after the pharyngeal swallow?

Answer 17

once the bolus passes through the UES

Question 18

Once the bolus passes through the UES what happens with breathing?

Answer 18

there is a reflexive exhalation

Question 19

In infants how is the epiglottis different?

Answer 19

It remains in contact with the velum during the oral phase for extra airway protection

Question 20

For infants what does the epiglottis’s anatomical position aid in?

Answer 20

it aides in directing the bolus laterally to pyriform sinuses for swallow
(vs. medially towards the vocal folds)

Question 21

What is the vallecular space/vallecula/valleculae

Answer 21

small reservoir forms at base of tongue and epiglottis

Question 22

Is poling of food and liquid in the valleculae normal?

Answer 22

NO

Question 23

Where do infants trigger their swallow at?

Answer 23

the valleculae

Question 24

what is a pocket that is formed by fibers running from the thyroid cartilage to cricopharyngeal sphincter?

Answer 24

pyriform sinuses

Question 25

Is pooling in the pyriforms normal?

Answer 25

NO

Question 26

what is the UES or CP mad up partially of?

Answer 26

the inferior pharyngeal constrictor

Question 27

The CP is partially opened by?

Answer 27

partially opened by the movement of the larynx pulling on the CP muscle and causing it to stretch and open therefore relax

Question 28

T or F the esophagus and stomach begin bellow the CP

Answer 28

true

Question 29

T or F the bolus travels down esophagus via peristalsis

Answer 29

true

Question 30

LES is the porthole between what?

Answer 30

the esophagus and the stomach

Question 31

what is the LES's job?

Answer 31

to allow food into the stomach and it is what keeps food from refluxing back up into esophagus and pharynx

Question 32

True or False.swallowing is a step by step process and things do not happen simultaneously.

Answer 32

False things happen simultaneously in a synchronized manner

Question 33

what are the 9 steps of swallowing pharyngeal phase?

Answer 33

1. bolus passes over the anterior faucial pillars and other posterior oral receptors and triggers the pharyngeal swallow (at vallecuale for infants) 2. vf adduct and clos, closing off opening to trachea 3. soft palate velum elevates to meet the posterior pharyngeal wall to close of nasal cavity 4. base of tongue retracts to meet the posterior lateral pharyngeal constrictors to push the bolus downward via peristaltic wave motion (pharyngeal stripping) 5. larynx moves anteriorly (minimal with infants) which causes the epiglottis to invert, partially covering the opening to the airway 6. bolus passes through the pharynx 7. bolus passes through cp sphincter initiating the esophageal phase of the swallow (esophagus uses peristaltic to propel the bolus down) 8. all structures that are open and return to the resting position and breathing resumes after a reflexive exhalation 9. there should be nothing coating the pharynx all materials of the bolus are gone.

Question 34

do the 4 seals create positive pressure or negative?

Answer 34

positive

Question 35

what are the 4 seals?

Answer 35

anterior seal velopharyngeal vocal fold closure Cp

Question 36

what makes up the anterior seal?

Answer 36

anterior tongue against the hard palate creates pos pressure

Question 37

what 3 things cause the bolus to move downward?

Answer 37

- the 4 seals create positive pressure - Negative pressure of the hyoid and larynx moving anteriorly and elevating - muscle contraction of the pharyngeal constrictors and the base of tongue

Question 38

what creates negative pressure during the pharyngeal phase to propel bolus down?

Answer 38

hyoid and larynx move anteriorly and elevate this creates a negative space which builds negative pressure and pulls the bolus in that downward direction where they were positioned at rest.

Question 39

what muscles contract to propel the bolus downward during the pharyngeal swallow?

Answer 39

posterior pharyngeal constrictors and base of tongue contract and meet each other in a top-bottom peristaltic wave to push bolus down (the pushing pressure of the muscles also creates some pos pressure

Question 40

In pedi anatomy where is the larynx located compared to adults?

Answer 40

in adults the larynx is located at the c5-c6 in pedis it is higher and is located at c2-c3 it sits close to the base of the epiglottis

Question 41

True or false: the hyoid bone sits more anterior and higher as well

Answer 41

True

Question 42

from birth to 6 mos the velum and epiglottis are in contact with each other at rest and during oral phase (secondary to epiglottis's elevated position which causes infants to be what kind of breathers?

Answer 42

this causes infants to be obligate nose breathers | they cannot breath out of mouth

Question 43

T or F. the epiglottis is shorter narrower softer and projects posteriorly at an 45 degree angel close to a horizontal position

Answer 43

True

Question 44

T or F. The posterior wall moves further anteriorly in children to contact the base of tongue during swallow to push bolus downward

Answer 44

True