A&P of Swallowing (ch2) Flashcards
Name some Oral Structures involved in swallowing.
Lips, teeth (24 deciduous, 32 permanent), maxilla (hard palate), velum (soft palate)–shared with oropharynx, uvula, mandible, floor of mouth, tongue (all but base), faucial arches (anterior and posterior), palatine tonsils, sulci (anterior and lateral), salivary glands (parotid, submandibular, sublingual)
What are the Oral Tongue Muscles involved in swallowing?
Intrinsics: superior longitudinal, inferior longitudinal, transverse, vertical (alter shape)
Extrinsics: genioglossus, hyoglossus, styloglossus, palatoglossus (protrude/retract, elevate/depress)
What are the Oral Roof-of-Mouth Muscles involved in swallowing?
Palatoglossus: in anterior faucial arch; pulls velum down and forward against back of tongue
Palatopharyngeus: in posterior faucial arch; helps elevate & retract velum (VP closure)
Name some Pharyngeal Structures involved in swallowing.
Pterygoid plates on sphenoid bone (nasopharynx), velum (oropharynx), tongue base, mandible, hyoid bone, pharynx (pharyngeal walls), epiglottis, thyroid cartilage, cricoid cartilage, vallecula, pyriform sinuses
What are the Pharyngeal/laryngeal Muscles involved in swallowing?
- Suprahyoids/submentals: mylohyoids, geniohyoids, digastrics (anterior belly)
- Infrahyoid: thyrohyoid
- Pharyngeal Constrictors: superior, middle, inferior > posterior & lateral walls
- Cricopharyngeus (CP): inferior constrictor fibers attached to cricoid lamina; prevents (excessive) air from entering esophagus and reduces backflow; tonic/contracted closed at rest (when awake); divides pharynx and esophagus
What swallowing phase begins when food goes through the UES?
Esophageal phase
Name some Laryngeal Structures involved in swallowing.
Hyoid bone, epiglottis, valleculae, laryngeal vestibule (from epiglottis down to VFs), aryepiglottic folds>lateral vestibule walls, thyroid cartilage, arytenoid cartilages, false VFs, true VFs, ventricles (lateral)
What are valleculae?
Little pockets above and to the side of epiglottis that catch premature spillage
What are the Laryngeal Muscles involved in swallowing?
-PCA: attaches cricoid lamina to arytenoid; abducts arytenoids/VFs for respiration at end of swallow
-LCA: attaches cricoid cartilage to arytenoid; adducts arytenoids/VFs
-Interarytenoid: attaches 2 arytenoids; adducts arytenoids/VFs
-Thyroarytenoid: attaches thyroid cartilage to arytenoid; tilts arytenoids anteriorly during swallow to assist with airway closure
-Laryngeal strap muscles:
-Thyrohyoid: elevates and lowers larynx
- Sternothyroid: suspends larynx & trachea
in neck
- Sternohyoid: lowers & stabilizes hyoid
What muscles make up a vocal fold?
Thyroarytenoid along with vocalis m.
Name the Esophageal Structures involved in swallowing.
- UES: aka CP (cricopharyngeus) or PE segment (pharyngoesophageal sphincter)
- Esophagus: ~25 cm long
- LES
What are the Esophageal Muscles involved in swallowing?
- UES: keeps air out of esophagus, keeps contents swallowed from not coming back up
- LES: keeps contents in stomach
- 2 layers of muscle in esophagus: inner circular & outer longitudinal (striated & smooth muscle)
How long does the Oral Prep/ Oral Phase take?
Time varies with bolus consistency
What is included in the Oral Prep/Oral Phase?
labial m. lingual movement, sensory receptors, buccal m., nose breathing
Define Mastication.
Rotary lateral movement of jaw and tongue
What is involved in Bolus Formation?
The tongue mixes the food/drink with saliva
True or False: 96% of normal swallowers are “dippers”
False. They “tippers”
What is the path of Bolus Transport in the oral prep/oral stage?
Tongue moves bolus posteriorly form the oral cavity to the pharynx
- increased viscosity=decreased volume=increased pressure=increased muscle activity
- multiple swallows
How long does the Pharyngeal Stage take?
~1 second; it’s the fastest stage!
What are the 6 steps of the pharyngeal stage?
1) velum elevates and retracts for VP closure; bolus transports with tongue base retractions and pharyngeal wall contraction
2) epiglottis inverts, hyolaryngeal elevation and protraction
3) closure of larynx
4) CP opening
5) Transport by pharyngeal constrictors
6) CP closure; larynx rests
What are the first and second lines of defense in swallowing?
1st line: Epiglottis
2nd line: VFs
In healthy normal swallowers, when is the swallow triggered?
When the head of bolus hits anterior faucial pillars
Define Delayed Pharyngeal Swallow.
If pharyngeal stage was not triggered when bolus head passes between faucial arches and tongue base
How long does the Esophageal Stage last?
8-20 seconds; transit time measures from UES to LES
What is included in the Esophageal Stage?
- bolus flow through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall
- relaxation of LES allows bolus to flow into the stomach
Describe the typical swallow for the younger population?
They are not as susceptible to penetration aspiration
- higher hyoid and layrnx (better protection), less elevation
- lower velum, shorter pharynx
- uvula in epiglottis, pocketing valleculae
- pharyngeal swallow is triggered at anterior faucial arch (bolus flow uninterrupted, no pause)
Describe the typical swallow for an older population?
- ossification of cartilages and hyoid
- pharyngeal swallow triggered when bolus head reaches middle of tongue base
- 70+ have a lower larynx
- arthritis in C vertebrae impinge on pharyngeal wall
- “dippers”
- delay, residue, penetration typical
- reduces hyolaryngeal excursion, plateaus at CP opening
- reduced CP opening flexibility
Describe swallowing variations in a neurologic population?
-pharyngeal swallow triggered when bolus head reaches middle of tongue base or when it falls into preforms (behind larynx)
