1 Oral Phase of Swallowing Flashcards
1
Q
- ORAL PHASE IS __________
A
VOLUNTARY *
-some kids will reject food entering their mouth and / or spit it out
2
Q
- Lips—obicularis oris
A
- Closure prevents anterior loss of bolus.
* Closure creates anterior seal during swallowing.
3
Q
Lips - Infant suckling
A
- Infant suckling: lips flare out on nipple but are not a vital part of sucking (they do not make the anterior seal during suckling). use tongue and hard palate. Babies with a cleft lip can get a seal for breast feeding
4
Q
Lips - Older children and adult sucking
A
- Older children and adult sucking: lips contract on straw/spout to form anterior seal (for negative pressure buildup).
5
Q
- Jaw—mandible, and associated muscles for opening/closure
Suckling
A
- Suckling: Jaw elevates and depresses during suckling.
Baby: elevation and depression, amount of elevation maters
Adults: rotary chew
6
Q
Jaw–mandible, and associated muscles for opening/closure
Mastication
A
- Mastication: Jaw elevates, depresses, and moves diagonally to grind food during chewing (patterns develop and mature as child grows).
7
Q
Jaw–mandible, and associated muscles for opening/closure
Jaw grading
A
- Adequate strength and stability allows for jaw grading = ability to move jaw from one height to another smoothly and with control (as in opening a slight amount for spoon vs. full opening, depressing jaw just enough during chewing vs. full opening).
- Jaw grading: figuring out how far to open mouth for the task
8
Q
- Cheeks—buccinator muscle
Infants vs. Older Children
A
- Infants: sucking pads provide structure/stability to prevent buccal pocketing; aide in creating positive pressure on nipple.
- Older children: muscle tension/tone provide structure.
9
Q
- Hard Palate (3)
A
- Tongue contacts hard palate to form anterior oral seal. –> for babies suckling the nipple. The lips create an oral seal for older. Creates negative pressure
- Slightly elevated contour of palate aides in moving bolus posteriorly.
- Vaulted palate happens frequently with intubated babies, can create minor problems
10
Q
- Soft Palate or Velum (3)
A
- Elevates to close off nasal cavity when swallow reflex is triggered.
- Thus creating a seal between velum and posterior pharyngeal wall.
(4 oral pharyngeal seals)
- Infants only: Contacts epiglottis to form a posterior oral seal during sucking ( => airway protection) and breathing.
11
Q
- Tongue (Lingual)–Intrinsic muscles (4) and extrinsic muscles (4)
A
Intrinsic: superior longitudinal, inferior longitudinal, transverse, vertical
Extrinsic: genioglossal, hypoglossal, styloglossal, palatoglossal
12
Q
Tongue characteristics and fncs:
A
- “Oral tongue” = refers to portion of tongue directly in oral cavity.
- Posterior portion of tongue remains slightly elevated during oral bolus manipulation to prevent bolus from leaving oral cavity before swallow is triggered.
- If the child has hypo-tone issue, the tongue cannot maintain posterior elevation during the oral phase
- Hyper-tonic tongues also cannot control the bolus
- Fix posterior tongue elevation and they will stop aspiration lots of times!
*Also involved in suckling, mastication, and preparation for swallowing
13
Q
Tongue
Suckling
A
- Infant suckling: Anterior to posterior movement as well as slight depression creates negative pressure. Elevation causes compression on nipple to create positive pressure.
- Older children and adult sucking: Lingual retraction creates negative pressure.
14
Q
Tongue
Mastication
A
- Mastication:
- Tongue tip lateralization transfers bolus (most important for safe chewing) to teeth for chewing. ability for the tongue tip to lateralize and the posterior tongue elevation = the most important parts of the oral phase
- Lateral portion of tongue and buccal tension keep food on teeth during chewing.
- Helps mix saliva with food to form a cohesive bolus.
15
Q
Tongue
Preparation for Swallowing
A
- Preparation for swallowing:
- Intrinsic muscles contract to create a concave “trough”—lateral borders of tongue are elevated to contact hard palate.
- Anterior portion of tongue elevates and posterior portion depresses and retracts to allow the bolus to be propelled posteriorly. (Think of a playground slide.)
- Swallow reflex is triggered by proprioceptive receptors scattered over base of tongue (anterior faucial pillars, uvula, posterior pharyngeal wall, etc.).
- Touch receptors and pressure receptors in the mouth.
- E.g. saliva – don’t get a lot of pressure receptors, so we let saliva slide down further before we initiate a swallow
- E.g. Steak, get more pressure sensory receptors engaging so we initiate the swallow sooner
