5:00 Swallowing Flashcards
Where is the oral vestibule?
The space between the lips and teeth
What are the two kinds of aspiration?
2
Food goes up the nose
Food goes down the lungs
What is silent aspiration?
Food goes down the lungs without the person realizing it.
What is the difference between striated & smooth tissue?
Striated is voluntary, smooth is involuntary
What part of the esophagus is composed of striated muscle?
The upper third
What part of the esophagus is composed of smooth muscle?
The lower two thirds
What innervates the esophagus?
Vagus & sympathetic divisions of the nervous system
Vagal activity increases ______.
Esophageal activity
What makes up the Upper Esophageal Sphincter (UES)?
2
Cricoid lamina
Cricopharyngeal muscle fibers (inferior constrictor)
What does the Upper Esophageal Sphincter (UES) do?
2
Prevents air from entering the esophagus during respiration
Prevents material from reflexing back up the esophagus and into the pharynx
What does the Lower Esophageal Sphincter (LES) do?
Prevents gastric reflux
What are the four phases of swallowing?
Oral Prep Phrase
Oral Transport Phase
Pharyngeal Transport Phase
Esophageal Transport Phase
What is the Oral Prep Phase?
4
Food enters mouth and is chewed
Bolus is prepped
Saliva is incorporated into food
Liquid is collected for drinking
What is the Oral Transport Phase?
Food is moved from the front of the mouth to the back of the mouth
What is the Pharyngeal Transport Phase?
2
Food is transferred to the pharynx towards the esophagus
The velopharyngus, vocal folds, and epiglottis are closed
What is the Esophageal Transport Phase?
Food is transferred into the esophagus
Which swallowing phases are voluntary?
2
Oral Prep Phrase
Oral Transport Phase
Which swallowing phases are involuntary?
2
Pharyngeal Transport Phase
Esophageal Transport Phase
What happens to the tongue during the Oral Prep Phase?
It is dished and moves posteriorly
What are the three types of salivary glands?
Submandibular (under jaw)
Sublingual (under tongue)
Parotid
(There are other smaller glands)
What does saliva do?
4
Maintains oral moisture
Reduces tooth decay
Assists in digestion
Holds bolus together
What are the two different kinds of saliva?
Viscous (watery)
Serous (thick & mucousy)
What happens during the Oral Phase?
2
Bolus is transported from anterior mouth to mid oral cavity via tongue
Tongue touches velum & faucial pillars triggering the velum
What triggers the Pharyngeal Phase?
The bolus passing over the back of the tongue
What happens during the Pharyngeal Phase?
2
Airway is protected
Bolus is moved
How is the airway protected during the Pharyngeal Phase?
4
Velopharynx is closed
Hyo-larynx is pulled up and forward
Vocal folds close
Eversion of the epiglottis
What makes the bolus move during the Pharyngeal Phase?
3
Peristalsis - progressive contraction of the pharynx
Pressure behind the bolus
Lubrication- serous saliva by the parotid glands
What is the path of the bolus during the Pharyngeal Phase?
3
It moves from the back of the tongue and valleculae
It separates into two equal parts and course around larynx & epiglottis through the pyriform sinuses
The two halves join once they reach the esophagus
What happens during the Esophageal Phase?
4
Upper esophageal sphincter is relaxed
Generation of low pressure in front of the bolus
Esophageal peristalsis (coursing contraction & relaxation
Dilation of the lower esophageal sphincter
What happens to airflow when we swallow?
We slightly exhale then have a period of apnea
What three things are unique to swallowing in the infant?
Rooting reflex
Sucking reflex
Breathing while swallowing
How many times does a baby suck before swallowing?
3-4
What happens to the velum while an infant is sucking?
It locks between the epiglottis & the tongue
What controls the voluntary phases of swallowing?
Cortex
What controls the involuntary phases of swallowing?
3
Central pattern generator
Pre-programmed sequential commands
Medulla
What transmits sensory information from the swallowing areas?
Nucleus Tractus Solitarius (NTS)
What transmits motor information to the swallowing areas?
Nucleus Ambiguus (NA)
The _______ and ______ tracts carry inputs from cortical motor centers in the frontal lobe and converge on ___________ in the lower brainstem.
Corticospinal
Corticobulbar
Central Pattern Generators
What do descending neural tracts do?
Carry motor info
What descending neural tracts carry information from the medulla for swallowing?
Nucleus Ambiguus (NA)
What nerves carry motor information for swallowing?
5
Trigeminal (CN V)
Facial (CN VII)
Glossopharyngeal (CN IX)
Vagus (CN X)
Hypoglossal (CN XII)
What does the Trigeminal (CN V) do for swallowing?
2
Innervates muscles of mastication
Facial sensations
What does the Facial (CN VII) innervate for swallowing?
2
Innervates Lip & Buccal muscles
Sensory for front 2/3 of tongue
What does the Glossopharyngeal (CN IX) & Vagus (CN X) innervate for swallowing?
(3)
Innervates Palate, Pharynx, Esophagus, Larynx, & Respiratory control centers
Sensory for back 1/3 of tongue
Sensation for Palate, Pharynx, & Larynx
What does the Hypoglossal (CN XII) innervate for swallowing?
Muscles of the tongue
What do ascending neural tracts do?
Carry sensory information to the brain
What ascending neural tracts carry information to the medulla for swallowing?
Nucleus Tractus Solitarius (NTS)
What nerves carry sensory information for swallowing?
4
Trigeminal (CN V)
Facial (CN VII)
Glossopharyngeal (CN IX)
Vagus (CN X)
What happens in the Central Pattern Generator?
3
Input arrives from NTS and is summed
If stimulus threshold is reached, NTS organizes the preprogrammed sequential spatial-temporal sequence of swallow
Sends info to NA to execute motor sequence
What are the two categories of variables that influence swallowing?
(2)
Bolus characteristics
Swallow mode
What are the three characteristics of the Bolus that influence swallowing?
(3)
Consistency
Volume
Taste & temperature
What are the three characteristics of the Swallow Mode that influence swallowing?
Single swallow vs. sequential swallows
Mealtime eating vs. swallowing during a swallow test
Cued swallows vs. uncued
What are two swallowing disorders?
Dysphagia
Orofacial mylofunctional disorder (OMD)
What is Dysphagia?
Difficulty in swallowing secondary to paralysis/paresis
What phase is affected in Dysphagia?
Pharyngeal
What can cause Dysphagia?
4
Aging
Degenerative neural disease
Stroke
Trauma
What can be used to diagnose Dysphagia?
3
Barium swallow
Modified barium swallow
FEES
What is OMD?
Difficulty in swallowing secondary to dysfunctional muscle patterns and oral habits
What is OMD also known as?
4
Tongue thrust
Immature swallow
Anterior positioning of tongue
Anterior tongue carriage
What six characteristics define OMD?
Abnormal thumb, finger, lip, and tongue sucking habits
Inappropriate lip-open resting position
Forward interdental rest posture of tongue
Forward rest position of the tongue agains the incisors
Lateral, posterior interdental tongue rest posture
Inappropriate thrusting of the tongue in speaking and/or swallowing
What are the consequences of mouth breathing?
5
Thickened mucous and/or tooth decay
Decrease nostril and nasal cavity size
Anterior tongue carriage
Abnormal facial growth
Possibly sleep apnea
What are some symptoms of tongue thrust?
3
Open bit - possible malocclusion
Reverse swallow
Contraction of mentalis muscle
Why is tongue position so important?
3
Dentition
Feeding
Physiology of the orofacial structure
