1.2 Intro & Anatomy Flashcards
What is dysphagia?
The inability to swallow
What is a bolus?
a food ball
What is laryngeal penetration?
Anything entering the larynx
What is aspiration?
when it goes below the level of the vocal folds
What is residue?
food that is left in the vocal tract after we complete a swallow. The type of residue tells about the anatomy structure.
What kind of function is swallowing?
a neuro-motor function like speech production
What accompanying disorder do children and adults with neuro-motor speech disorders have?
a swallowing disorder
Speech-production and swallowing involve what anatomical structures?
The same
Who else works with patients with swallowing disorders?
11
- Otolaryngologist
- Gastroenterologist
- Radiologist
- Neurologist
- Respiratory therapist
- Occupational therapist
- Dietician
- Dentist
- Nurse
- Neurodevelopmental specialist
- Patient’s family
When is an inpatient acute setting utilized?
When a patient first has the event, such as a stroke, and goes to the hospital
When is an inpatient sub-acute setting utilized?
Where a patient goes after acute or when prognosis gets better
When is an inpatient rehabilitation setting utilized?
Where a patient goes after they are stable but unable to be left alone
What is an outpatient clinic setting?
It is like what we have at ECU
When is an home health setting utilized?
When a patient gets to go home and a SLP goes to their house to provide therapy
What structures are involved in the Oral stage?
1 + 8
Oral Cavity:
- Lips
- Jaw
- Tongue
- Hard palate
- Soft palate
- Cheek
- Mandible
- Maxilla.
What structures are involved in the Pharyngeal stage?
4
Base of the tongue
Soft palate
Larynx (hyoid bone, epiglottis, laryngeal vestibule, true and false vocal folds, ary-epiglottic folds)
Cricopharyngeus.
What structures are involved in the Esophageal stage?
Esophagus
What muscle opens up the UES?
Cricopharyngeus
What are the four muscles of mastication
Masseter
Temporalis
Medial pterygoid
Lateral pterygoids
.
What nerve innervates the muscles of mastication?
The trigeminal nerve
What are the important cranial nerves for speech?
5
- Trigeminal (V)
- Facial nerve (XII)
- Glossopharyngeal (IX)
- Vagus (X)
- Hypoglossal (XI)
.
What is the most important muscle of mastication?
Lateral pterygoid
What is affected when the trigeminal nerve is damaged?
Mastication
What is an important muscle for lip closure?
Orbicularis oris
When does anterior spillage happen?
It happens when there isn’t complete closure of the orbicularis oris
(Food spills out the front of the mouth )
What is posterior spillage?
When food prematurally spills out at the back of the mouth
What muscles are important to know about the lips?
5
- Levator labii superioris
- Zygomaticus Major
- Zygomaticus Minor
- Depressor anguli oris
- Depressor Labii inferioris
.
What is the risorius muscle responsible for?
It is responsible for stretching out the sides of the mouth for smiling
How is the facial nerve involved with the tongue?
It senses taste in the anterior 2/3 of tongue
What does the tensor veli palatini muscle do?
Tenses the palate (adds the bulk)
What does the levator veli palatini muscles do?
Elevates the palate
What does the palatopharyngeus muscle do?
2
Closes the nasopharynx
Pull the pharynx upward behind the bolus of food (and nearly come together)
What does the palatoglossus muscle do?
2
It raises back of tongue to connect with the palate
Narrows fauces (assuming to make sure bolus is small enough to swallow)
What does the uvula do?
Triggers the gag reflex
What nerve controls all of the muscles of the palate except for the tensor veli palatini?
Vagus nerve
What nerve innervates the tensor veli palatini?
Trigeminal nerve
What are the four supra-hyoid muscles?
Geniohyoid
Digastric
Mylohyoid
Stylohyoid
What is the most important suprahyoid muscle for the superior and anterior movements?
Geniohyoid
What three supra-hyoid muscles are involved in superior movement?
Digastric
Mylohyoid
Stylohyoid
What is the stylohyoid muscle innervated by?
Facial nerve
What is the geniohyoid muscle innervated by?
Hypoglossal nerve
What nerve innervates the mylohyoid and digastic?
Trigeminal nerve
What is the anterior movement of the larynx important for?
Protection
What is the superior movement of the larynx important for?
Opening up the UES
What are the extrinsic muscles of the tongue?
4
Palatoglossus
Styloglossus
Hyoglossus
Genioglossus
What is the Oral Preparatory Phase?
Preparing the food or liquid into a bolus
What does the Oral Preparatory Phase require?
1+5
Requires coordination of…
- Lips
- Tongue
- Teeth
- Mandible
- Cheeks
What happens in the oral phase?
Bolus is propelled to the back of the mouth (oropharynx)
What is the duration of the oral phase?
duration: 1 to 1.5 sec
What are the steps of the pharyngeal phase?
7
- Velopharyngeal closure
- Tongue base retracts to posterior pharyngeal wall
- Closure of the epiglottis
- Hyoid elevation and laryngeal vestibule squeeze
- Approximation of the true and false vocal folds
- Pharyngeal stripping
- Opening of the UES
.
What does the oral prep phase require?
What is it negatively affected by? (3)
Intact dentition //
Poor salivary function
Surgical defects
Neurological disorders.
What is triggered when food enters the mouth?
Sensory receptors (taste, smell, pressure, temperature).
How does oral hygiene factor into aspiration?
2
Individuals with bad oral hygiene are more likely to develop pneumonia due to aspiration.
Having good oral hygiene decreases the change of developing pneumonia due to aspiration.
Which glands produce saliva?
3
Parotid
Sub-mandibular
Sub-lingual
What is important about the parotid gland?
It is the largest but doesn’t produce the most saliva
What are the two types of saliva?
Thin watery (serum-like) or thick (mucous like)
Why is saliva important?
3
Oral hygiene
Keeping micro-organisms away
Bolus formation
What does the sub-mandibular gland produce?
Produces a combination of thin and thick liquid (responsible for 60 to 70%)
What does the sub-lingual glands produce?
It only produces thick saliva
What do you need to have a good saliva production?
Good oral hygiene
What is the clinical term for dry mouth?
Xerostomia
What nerve controls taste
sensation for the anterior 2/3rd of tongue and general sensation hard palate, and soft palate?
Facial Nerve
What nerve controls Oral Sensation for the posterior 1/3rd of tongue?
Glossopharyngeal Nerve
How does oral sensation travel to the sensory cortex?
4
Oral/pharyngeal areas ->
Nucleus Tractus-Solitarius ->
Thalamus ->
Sensory cortex
In regards to the oral phase, what does the mastication muscles do?
(2)
Form the bolus
Bolus is placed on the tongue blade
What is the second step of the oral phase?
2
Tip of the tongue is elevated and backward
Motion of the bolus into the oro-pharynx is initiated.
What is the third step of the oral phase?
2
Extrinsic tongue muscles and palatal muscles work to push bolus posteriorly
Nasopharynx is sealed
What is the forth step of the oral phase?
Sensory receptors in the posterior parts of the tongue and palate guide the initiation of pharyngeal swallowing.
What sequential activation happens during the start pharyngeal phase?
Sequential activation of superior, middle and inferior constrictor muscles
What is the 2nd step of the pharyngeal phase?
Contraction of the posterior portions of the tongue
Forward movement of Lower Pharyngeal Wall (LPW) and Posterior Pharyngeal Wall (PPW).
What is the 3rd step of the pharyngeal phase?
What contributes to it?
Pharyngeal stripping,
Flow-pressure dynamics (movement from high pressure zones to low pressure zones)
What is the 4th step of the pharyngeal phase?
Simultaneous activation of supra-hyoid muscles to move the hyoid bone upward and forward.
What is the 5th step of the pharyngeal phase?
What happens during it? (2)
Closure of the larynx //
Epiglottic inversion
Laryngeal squeeze
What is the last step of the pharyngeal phase?
Food reaches the level of Upper-esophageal segment.
During the esophageal phase, what is triggered as the bolus enters the UES?
Peristalsis
wave-like muscle contractions that moves food
Is there only one peristalsis?
There is a primary peristalsis and secondary peristalsis for every bolus
During the esophageal phase, What propels the bolus to the LES?
Alternate ring like contractions
During the esophageal phase, what happens if food is not cleared away by a primary peristalsis?
A secondary peristalsis happens to move boluses residue
How is the esophageal phase assessed?
Manometry (this is not a part of our field)
What is the white out period during a videoscopy?
This is when the screen goes white because everything squeezes.
What is swallowing apnea?
When does it happen?
Momentary cessation of breathing during a swallow
It occurs when the vestibule is being squeezed
What is pharyngeal stripping?
???
When hypoglossal is impaired, what stage of swallowing will be most affected?
(2)
Oral Prep
Oral Stage
What muscles are used in pharyngeal stripping?
Pharyngeal Constrictors
How is the Internal Branch of SLN involved in swallowing?
What happens when it is impaired? (2)
Sensation within larynx //
Loss of ability to sense when to cough
Silent aspiration
