Chapter 2 Swallowing

Speech Language Pathology 452 with Logomen at University of Illinois - Urbana-Champaign

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By: Sara Belczak
Created: 2011-04-06
Size: 49 flashcards
Views: 18

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Anatomic areas involved in deglutition

oral cavity
pharynx
larynx
esophagus

Oral Cavity structures

lips
teeth
hard palate
soft palate
uvula
mandible
floor of mouth
tongue
faucial arches

musculature of floor of mouth

mylohyoid

geniohyoid

anterior belly of digastric

hyoid bone suspended by

soft tissues by the floor of mouth
posterior belly of digastric
stylohyoid

oral tongue

tip, blade, front, center, back
ends at the circumvallete papillae
under cortical/voluntary control

pharyngeal portion tongue

tongue base
begins at circumvallete to hyoid bone
active during pharyngeal stage of swallow
involuntary neural control in brainstem (medullary) but possible some voluntary control

Roof of Mouth

hard palate (maxilla)
soft palate (vellum)

may be pulled down/forward against back of tongue by the palatoglossus muscle

uvula

Salivary Glands

parotid: serous fluid
subamndibular: serous and watery fluid
sublingual: serous and watery fluid

Pharyngeal Constrictors

superior, medial, inferior
superior arrives from median raphe
inferior fibers attach to tongue base (glossopharyngeus muscle)

Pyriform sinuses

space between inferior pharyngeal constrictor and thyroid

-20% of normal swallows food only goes down one pyriform sinus

Cricopharyngeal Muscle

always tense
attaches to posterolateral surface of cricoid lamina
reduces risk of backflow from esophagus
2-4 cm zone of elevated pressure
greatest pressure immediately prior to swallowing & during inspiration
opens to let bolus pass into esophagus

Esophagus

collapsed muscular tube 23-25 cm long
sphincter/valve at each end
2 layers of muscles
inner circula
outer longitudinal
passes through neck, chest, diaphragm, to attach to stomach
in neck sits behind trachea

Epiglottis

topmost structure of larynx
1/3 of epiglottis rests at the base of the tongue
attaches to hyoid bone
base attached to thyroid notch

Valleculae

wedge shape space formed between base of tongue and epiglottis

laryngeal vestibule

opening into the larynx

aryepiglottic folds

aryepiglottic muscle

quadrangular membrane

cuneiform cartilages

True Vocal Folds

last level of airway protection
vocalis and thyro-arytenoid muscle

Deglutition: first 2 phases

Oral Preparatory phase: food is manipulated in the mouth and masticated if necessary reducing it to a consistency ready for swallow
Oral Phase: tongue propels food posteriorly until pharyngeal swallow is triggered

Deglutition: 3 + 4 phases

Pharyngeal Phase: bolus moved through pharynx
Esophageal phase: peristalsis carries bolus through the cervical and thoracic esophagus and into the stomach

swallowing and respirations relationship

-swallowing and respiration are reciprocal functions

-respiration halts during the pharyngeal stage of deglutition in all humans of all ages

Oral Prepatory Phase

recognition of food approaching mouth
prep movements vary depending viscosity
labial seal is required to ensure food doesn't fall from mouth
open nasal passage; breathing
thicker consistencies require chewing
sensory information
larynx/pharynx at rest

tongue thrust

holding the bolus more anteriorly between the tongue and the anterior teeth
abnormal pre-swallowing position

liquid in prepatory stage

liquid bolus has certain degree of cohesiveness
tongue cups the liquid bolus with the sides of the tongue sealed against teh lateral alveolus

tippers vs dippers

tipper: food held between the midline of the tongue and the hard palate with the tongue tip elevated and contacting the anterior alveolar ridge

dipper: food held on the floor of the mouth in front of tongue

-20% of normal swallowers are dippers

Premature spillage

soft palate is not pulled down and forward so food begins to "spill" down
normal during active chewing
not normal during the hold stage of liquids

Chewing

upper & lower teeth meet and crush food
food falls medially toward tongue, which moves material back onto teeth
rotary action
rhythmic movements are controlled by central pattern generator
peripheral feedback is important to prevent biting tongue

Viscosity

thickness of food
viscosity increases the maximum volume decreases

Oral Phase

starts: posterior movement of bolus
stripping action with the midline of the tongue squeezing bolus back
sides/tip tongue at alveolar ridge
1-1.5 sec
viscosity thickens; pressure of tongue increases
buccal musculature ensure food doesn't fall into sulci

Triggering Pharyngeal swallow

tongue base and oropharynx receptors send signal of swallow to cortex and medulla
brainstem decode info and IDs swallow stimulus
bolus head reaches faucial arch or trigger point the oral stage is terminated and pharyngeal begins

not triggered is delayed

receptors for pharyngeal swallow

tongue
epiglottis
larynx

swallowing voluntary or reflex?

BOTH

-voluntary occurs in prep and oral stage

-reflex occurs in pharyngeal stage

-neither mechanism alone is capable of producing a swallow with regularity/immediacy

Cranial Nerves in sensory portion of pharyngeal swallow

Pharyngeal swallow

elevation/retraction of velum
elevation/anterior movement of hyoid and larynx
close larynx
opening UES
ramping of base tongue to deliver the bolus to the pharynx followed by tongue retraction to contact pharyngeal wall
contraction pharyngeal constrictors

3 sphincters of larynx

laryngeal entrance

false vocal folds, arytenoids, thickening of epiglottic base as larynx elevates

epiglottis
true vocal folds

Velopharyngeal Closure

varies person to person
elevation/retraction soft palate (velum)
inward movement of posterior/lateral pharyngeal wall
allows build-up of pressure in the pharynx
possible to swallow without velopharyngeal closure

Closure of larynx

closure begins at true VF and moves up

if food penetrates it helps move it up

closure of the airway at the vestibule there is a downward/forward motion of arytenoids
narrows laryngeal opening
larynx elevated/forward
elevations thickens base of epiglottis

Cricopharyngeal opening

tension in cricopharyngeal muscle is released
sphincter "yanked" open by motion of larynx resulting from movement of larynx by the upward and forward pull of the floor mouth muscles
head of bolus reaches the sphincter as it opens

pressure widens opening

Tongue base and Pharyngeal wall

tongue base retraction and pharyngeal wall contact occurs when bolus tail reaches the tongue base
tongue moves most of the distnace
should make complete contact

build up pressure

pharyngeal wall contraction continues progressively down pharynx

Without a pharyngeal trigger

physiologic activities would not occur
bolus likely to be propelled into pharynx
may rest in valleculae/pyriform sinus
depending on consistency my drain from valleculae to aryepiglottic fold into pyriform sinuses or airway
no voluntary way to initiate

purpose of epiglottis

direct food around airway (into pyriform sinuses) rather than on top of airway

esophageal phase

time is point of entrance into UES until passes LES
8-20 seconds
motility disorder in esophagus can be defined during a videofluroscopic study

ability to move spontaneously and easily
need gastroenterologist

Infants

anatomic relationship between structures of oral cavity and pharynx is different
tongue fills oral cavity
fat pads in cheeks narrow the cavity
hyoid bone and larynx much higher in adults
velum hangs lower
swallowing in fetus
laryngeal elevation is less

Grow Patterns

bite is achieved at 7m
chewing occurs at 12m
greatest elongation of the pharynx and downward displacement of the larynx occur during puberty

Older Adults

masticatory performance maintained
ossification in thyroid and cricoid cartilages
70+ larynx lower in neck
more dippers
oral stage little longer and delay in trigger
increase in residence after 60
penetrate more but not aspiration
less reserve/flexibility

Taste

chemical sense in the oropharyngeal region activated during eating and drinking
rating of intensity of tast decreases with age

Volume

small volume will have a distinct oral phase followed by pharyngeal swallow

large volume will have simultaneous activity

Cup drinking

early airway closure and some pre-elevation of the larynx
airway closes 5-10 seconds
velopharyngeal are closed during sequential swallows
UES opens repeatedly

Straw Drinking

create suction of the soft palate is lowered against the back of tongue
muscle cheeks contract
modified way of bringing food to the mouth

Components of all swallows

oral propulsion of bolus
airway closure
UES opening
tongue based-pharyngeal wall propulsion to carry bolus through pharynx into esophagus
variation on normal swallow generally involve changing the relative timing of these elements but all must needed

About this deck

By: Sara Belczak
Created: 2011-04-06
Size: 49 flashcards
Views: 18

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj