Quiz 1 Flashcards
(20 cards)
Components of A Swallow
- Oral propulsion of the bolus into the pharynx
- Airway closure
- Upper esophageal sphincter opening
- Tongue base – pharyngeal wall propulsion of the material through the pharynx and into
the esophagus
Describe swallowing variations
- Material builds up in the valleculae and the pyriform sinuses
- The individual then produces a pharyngeal swallow with little or no oral swallow (dry swallow)
- If chewing is taking place, the individual will stop chewing, produce a
pharyngeal swallow and then return to chewing.
Describe chug-a-lug
The larynx is pulled forward which in turn opens the upper
esophageal sphincter volitionally
* Breath is held so as to close the airway at the level of the larynx
* The material is literally dumped through the oral cavity and pharynx
by gravity into the esophagus and stomach
* Requires tremendous volitional control
Describe Straw Drinking
Bolus is brought into the mouth via a suction created in the oral cavity (negative pressure)
- Soft palate is lowered against the back of the tongue and
the muscles of the cheek and face contract - When the material has reached the mouth – suction is stopped, and the soft palate elevates as the oral stage of
the swallow is initiated by the tongue.
Cup Drinking
early airway closure and some pre-elevation of the larynx
- Duration of the airway closure may last from 5 to 10 sec.
- Dependent upon the number of consecutive swallows
- During sequential swallows:
- Velopharyngeal area is closed, lips maintain seal around the cup/glass, tongue base and pharyngeal walls make contact at the tail of each sequential bolus
- Upper esophageal sphincter opens repeatedly for each sequential bolus
Stages of the Normal Swallow
Oral Stage – often divided into two phases
- Oral Preparatory Phase
When food is manipulated in the mouth and prepared for the swallow - Oral Phase
When the tongue propels the food posteriorly until the pharyngeal swallow
is triggered - Pharyngeal Stage
When the pharyngeal swallow is triggered and the bolus is moved through the
pharynx - Esophageal Stage
When esophageal peristalsis carries the bolus through the cervical and thoracic esophagus and into the stomach
Describe Oral Prep Phase
Sensory recognition component of the swallow
* Food approaches mouth
* Mouth begins to prepare
* Movements depend upon
* Type of material (viscosity)
* Solid/liquid
* Amount of material
Tongue Thrust?
When the bolus is more anteriorly between the tongue and the
anterior teeth.
* Tongue thrust (Reverse Swallow Pattern)
Oral Stage
Intact labial musculature
* To ensure an adequate seal
* Prevent material from leaking out of the oral cavity
Intact lingual movement
* To propel the bolus posteriorly
Intact buccal musculature
* To ensure that material does not fall into the lateral sulci
Normal palatal muscles
Ability to breathe comfortably through the nose
Pharyngeal stage
Sensory receptors in the oropharynx and tongue are stimulated
as the tongue moves the bolus posteriorly
- Send messages to the cortex & brainstem
- The oral stage of the swallow is terminated and the pharyngeal
swallow is triggered (typically) - When the bolus “bolus head” passes any point between the anterior
faucial pillars and the point where the tongue base crosses the lower rim
of the mandible
Epiglottis during the pharyngeal phase ?
- Directs the material around the airway rather than over the
airway - The two portions of the bolus join again at the level of the
opening of the esophagus
Describe the Cricopharyngeal Opening during the pharaoh phase?
Tension in the cricopharyngeal muscular portion of the sphincter is released
* Laryngeal anterior superior motion is seen to open the sphincter (o.1) seconds later
* The sphincter is yanked open by the motion of the larynx resulting from the
upward and forward pull of the floor of the mouth muscles
* The leading edge of the bolus reaches the sphincter and the pressure within the
bolus widens the opening
* The bolus passes through the sphincter
* The larynx lowers
* The cricopharyngeus muscle returns to same level of contraction
Describe the closure of larynx
Is a bottom-up process beginning with the true vocal folds and progressing
through the laryngeal vestibule
- Clears penetration
- Larynx is elevated and pulled forward
- Elevation thickens the base of the epiglottis, assisting in the closure of the laryngeal
vestibule - The airway is closed for ~1/3 to 2/3 second during a single swallow
- During sequential cup drinking for more than 5 seconds
Describe the Trigeminal Nerve V
Mastication – Temporalis, Masseter, Medial and Lateral Pterygoid
▪ Hyolaryngeal excursion – Mylohyoid, anterior belly Digastric
▪ Tensing velum – Tensor Veli Palitini
Bolus Manipulation
Describe the Facial Nerve Vll
Lip closure: Orbicularis Oris, Zygomaticus
▪ Buccal tone: Buccinator
▪ Hyolaryngeal excursion – posterior belly Digastric, Stylohyoid
Taste – Taste from the anterior 2/3 of the tongue
▪ Salivation – Parasympathetic fibers to the submandibular and
sublingual salivary glands
Glossopharyngeal Nerve lX
Pharyngeal constriction – Upper Pharyngeal Constrictor
Hyolaryngeal excursion – Stylopharyngeus
Sensory and Autonomic Innervation
▪ Taste and sensation – Sensation from the posterior 1/3 of tongue
(including taste), the velum, the fauces and the superior portion
of the pharynx
▪ Salivation – Parasympathetic fibers to the parotid salivary
glands
Describe the Vagus Nerve X
Velopharyngeal closure – Levator Veli Palatini
▪ Tongue base retraction - Palatoglossus
▪ Pharyngeal squeeze – Pharyngeal Constrictors
▪ Airway closure – All intrinsic laryngeal muscles
▪ UES closure and opening – Cricopharyngeus
▪ Esophageal motility – Esophageal musculature, both striated in proximal 1/3 as well as smooth muscle in distal 2/3 of esophagus
Sensory and Autonomic Innervation
▪ Sensation – Sensory information from the velum, posterior and inferior
portions of the pharynx and all sensation in the larynx
Accessory Nerve?
Pharyngeal Shortening - palatopharyngeal
Hypoglossal Nerve Xll?
Tongue Motility - all extrinsic & intrinsic mm
