Potential Implications to CNs

Question 1

V Trigeminal

Answer 1

• Bolus break down and preparation of solids
• Reduced anterior hyoid movement with consequent decreased epiglottic defection decreased opening of the UES with pyriform sinus residue and post-swallow aspiration
  
  • Decreased bolus recognition/awareness
  • Muscles of mastication (masseter, temporalis, lateral & medial pterygoids) – important for oral preparation / chewing. Suprahyoid muscle group (mylohyoid & anterior belly of digastric) – assists hyolaryngeal excursion.
• Tensor veli palatini (soft palate) – stretches soft palate & assists velopharyngeal seal.

Question 2

VII Facial

Answer 2

1. Reduced elevation of hyoid
   * decreased pharyngeal shortening and supraglottic compression, risk of intra-swallow aspiration
2. Reduced superior, posterior shortening of the tongue, hyoid, larynx

• premature spillage and pre-swallow pooling
• BOT to PPW approximation - post-swallow vallecular residue

3. Decreased Salivation

Suprahyoid muscle group (stylohyoid) – assists hyolaryngeal excursion.

Muscles of facial expression (orbicularis oris, buccinator) – Important for oral preparation & containment of the bolus. Also important for the pressure system (lip seal).

Posterior belly of digastric‐ muscle that elevates hyoid bone

Secretomotor to the submandibular & sublingual salivary glands – saliva production important for oral preparation, taste & oral hygiene.

Question 3

IX Glossopharyngeal

Answer 3

1. Reduced pharyngeal motility and reduced pharyngeal shortening
   * post swallow residue
2. Reduced supraglottic compression
   * risk of intra-swallow aspiration
3. Decreased BOT to PPW approximation
   * post-swallow vallecular residue
4. Decreased bolus recognition/awareness

Secretomotor to parotid gland – saliva production important for oral preparation, taste & oral hygiene.

Stylopharyngeus (SVE) – raises pharynx, compresses laryngeal walls and helps with pharyngeal compression

Question 4

X Vagus

Answer 4

1. Diminished capacity for laryngeal adduction
   * intra-swallow aspiration
2. Decreased effectiveness of cough n aspiration (motor)
3. Silent aspiration (sensory)
4. Impairment of the opening of UES

• post-swallow residue pyriform sinus
• post-swallow aspiration

Muscles of pharynx* (superior, middle & inferior pharyngeal

constrictors) – shorten & narrow the pharynx, important for pharyngeal clearance via peristalsis‐like movements.

Cricopharyngeus / UES – Releases or activates tonic contraction. Hyolaryngeal excursion critical to achieve maximal UES opening.

Intrinsic muscles of the larynx (cricothyroid, thyroarytenoid, cricoarytenoid, transverse & oblique arytenoids) – Important for airway protection / closure of the glottis.

Muscles of soft palate* (levator veli palatini, uvular, palatoglossus, palatopharyngeus) – important for velopharyngeal seal, which prevents nasal regurgitation & aids the pressure system.

Oesophagus (peristaltic wave).

Question 5

IX & X

Answer 5

1. Poor pre-swallow bolus containment

• premature spillage and pre-swallow pooling
• pre-swallow aspiration

2. Decreased pharyngeal shortening and supraglottic compression,
   * risk of intra-swallow aspiration

Question 6

XlI Hypoglossal

Answer 6

1. Poor bolus manipulation

• lack of cohesive bolus
• post swallow oral residue (buccal and sublingual)-oral hygiene

2. Decreased BOT to PPW approximation
   * post-swallow residue in valleculae.

tongue for oral preparation & oral transit.

Intrinsic tongue muscles – important for changing the shape of

Extrinsic muscles of tongue– important for oral preparation & manipulation of the bolus; oral containment (glossopalatal seal, fluids); oral transit (drop push); & pharyngeal propulsion via BOT to PPW approximation).

Suprahyoid muscle group– Assists hyolaryngeal excursion.