Anatomy of degluttion Flashcards
4 anatomic areas important in swallowing
Oral cavity
Pharynx
Larynx
Esophagus
What anatomic structures make up the oral cavity
-Lips
-tongue
-floor of mouth musculature
- hard palate
- soft palate
-teeth
-Cheeks & Buccal spaces or anterior and lateral sulci
-anterior and posterior faucial pillars
-uvula
3 parts of the pharynx
-nasopharynx
-oropharynx
-hypopharynx or laryngeopharynx
3 parts of the esophagus
-upper esophageal sphincter
-esophagus
-lower esophageal sphincter
5 most important cranial nerves for swallowing
-CN 5 (V) Trigeminal nerve
-CN 7 (VII) Facial nerve
-CN 9 (IX) Glossopharyngeal nerve
-CN 10 (X) Vagus nerve
-CN 12 (XII) Hypoglossal nerve
What 3 cranial nerves assist with sensory innervation of the tongue? Identify the part of tongue and function for each nerve
-Trigeminal (V) Nerve sensation of anterior 2/3 tongue
-Facial (VII) Nerve taste of anterior 2/3 tongue
-Glossopharyngeal (IX) Nerve sensation and taste of posterior 1/3 tongue
Branches and function of trigeminal nerve
-3 branches: Mandibular, Maxillary, and Ophthalmic
-Controls TMJ/Jaw, cheeks, and forehead movements
Function of facial nerve
Facial expression and taste of anterior 2/3 of tongue
Function of glossopharyngeal nerve
-Controls much of the tongue and pharynx movement (including soft palate elevation)
-taste and sensation of posterior 1/3 tongue
Function of vagus nerve
-Controls laryngeal and pharyngeal movement
-Sensation within larynx and pharynx
Function of hypoglossal nerve
Tongue movement
How would you assess trigeminal nerve
- Observe mandible at rest
- Observe mandible during chewing
- Observe mandible biting down
- Pt avoids mouth being forced open/closed
- Prick and/or cotton swab on gums to detect sensation
How would you assess facial nerve
- facial expressions
- face at rest
- wrinkle forehead
- tightly close eyes
- smile/kissy face/puffer face
- cotton swab taster
How would you assess glossopharyngeal nerve
- cough test
- tough posterior tongue with cotton swab vs tongue depressor
- say /ah/ & observe palatal movement
- cotton swab taster
How would you assess vagus nerve
- say /ah/ and watch palatal movement
- observe and listen to voice
- cough test
- sharp glottal closure
- observe swallowing ability
- test /k/ and /g/ sound production
How would you assess hypoglossal nerve
- stick out tongue
- ability to resist tongue being moved
- tongue range of motion (move it side to side; retract; up to alveolar; slide back against hard palate)
The oral cavity roof of mouth is formed by?
- uvula
- soft palate (velum)
- Hard palate (maxilla)
What is another name for soft palate
Velum
What is another name for hard palate
Maxilla
Sensory innervation of the velum?
Maxillary branch of the Trigeminal (V) nerve
4 muscles of the soft palate
- Palataglossus
- Levator Veli Palatine
- Tensor Veli Palatini
- Palatopharyngeus (PP)
What is the function of the PP muscle (Palatopharyngeus muscle)
Elevates and retracts soft palate for velopharyngeal port closusure
What is the function of the palataglossus muscle
Raises the back of the tongue
Where are the buccal spaces/pockets within the oral cavity?
2 Anterior sulci- between the lips and hard palate (maxilla) along upper jaw & between the lips and lower jaw-mandible
2 lateral sulci- between the cheeks, hard palate (maxilla), and mandible on each side of the mouth
What are the 3 salivary glands
- parotid gland
- submandibular gland
- sublingual gland
Where are salivary glands located>
In the mucous membranes of the tongue, lips, cheeks, and roof of mouth
Innervation of salivary glands
Autonomic nervous system parts: parasympathetic and sympathetic system
Function of saliva
- oral moisture
- oral hygiene (reduces bacteria on teeth & tooth decay)
- helps to break down food (digestion)
- Natural neutralizer of stomach acid that may reflux into esophagus
2 main functions of tongue papillae
Papillae are the little bumps on the top of your tongue that grip food while chewing and contain taste buds
4 types of tongue papillae
- filliform (most common, no taste buds)
- Fungiform (tip and sides; taste buds)
- Foliate (vertical folds on each side; taste buds)
- Circumvallate (taste buds from CN IX)
Sensory function of the tongue?
- Tactile sensation
- Taste
9 parts of the tongue
- anterior 2/3
- posterior 1/3
- palatoglossal fold
- palatine tonsil
- fungiform papillae
- circumvallate papillae
- sulcus terminalis
- foramen cecum (tongue base)
- foliate papillae
Extrinsic tongue muscles do what?
4 pairs of muscles that 1. move the tongue and 2. attach to various bones of the head and neck
Which tongue muscle aids in initiation of swallowing?
Extrinsic muscle Palatoglossus
Motor innervation of tongue
Hypoglossal (XII) Nerve for extrinsic and instrinsic muscles
*except palatoglossus extrinsic muscle, innervated by vagus (X) nerve
What are the of instrinsic tongue muscles and their function
4 intrinsic “tissues” of tongue muscle: inferior longitudinal, superior longitudinal, vertical, and transverse muscle
-small changes in the contour of tongue surface
-alter tongue shape for talking and swallowing (curl tongue tip, elevate tip and sides, broaden/lengthen tongue, and narrow/cup or deepen tongue)
Two functional divides of tongue
- oral tongue
- pharyngeal tongue (tongue base)
Location of oral tongue
Extends from tip to back, ending at the circumvallate papillae
Location of the pharyngeal tongue
Extends from circumvallate papillae to the hyoid bone
When is the pharyngeal tongue active during degluttion
During the pharyngeal stage of swallowing
Which structure forms the foundation for the tongue? How?
The hyoid bone
The tongue body sits on the hyoid bone
The hyoid bone is suspended in soft tissue by the…
- Mylohyoid muscle
- Geniohyoid muscle
- Anterior belly of digastric
- Posterior belly of digastric
- Stylohyoid
The larynx is suspended from the hyoid bone by which 2 structures?
- Thyrohyoid ligament (medial and lateral)
- Thyrohyoid muscle
Sensory innervation of the larynx
Vagus nerve:
SLN for supraglottis space
RLN for subglottis space
The pharynx extends from what to what?
Extends from the base of skull to lower border of cricoid cartilage
The nasopharynx is posterior to?
Posterior to the nasal cavity
The oropharynx is located along?
Along posterior of oral cavity
The hypopharynx or laryngeopharynx is located along?
The posterior of the larynx
Where are the pharyngeal muscles located?
Pharyngeal constrictors Make up the outer layer of the muscular walls of the pharynx
Longitudinal muscles make up the inner muscular layer of the pharynx
Name the pharyngeal constrictors and their innervation
All innervated by vagus (X) nerve
1. superior pharyngeal constrictor
2. Middle pharyngeal constrictor
3. Inferior pharyngeal constrictor
Name longitudinal pharyngeal muscles and their innervation
- Stylopharyngeus muscle- innervated by glossopharyngeal (IX) nerve
- Palatopharyngeus muscle- innervated by vagus (X) nerve
- Saplingopharyngeus muscle- innervated by vagus (X) nerve
Function of the longitudinal pharyngeal muscles
main function: Elevate and shorten the pharynx
(this in turn raises the larynx)
Also help to seal oral cavity and raise/lower palate
Motor and sensory innervation of the pharynx
MOTOR: glossopharyngeal (IX) nerve and vagus (X) nerve
(sometimes accessory (XI) nerve)
SENSORY:
glossopharyngeal (IX) nerve for oropharynx and vagus (X) nerve for rest of pharynx
Palatopharyngeus muscle origin and muscle direction/location?
This muscle aids in the movement of which two organs?
Origin from soft palate
Direction: along the length of the pharynx
Movement of Soft palate & pharynx
Where are the pyriform sinuses located?
Within the hypopharynx (laryngopharynx)
Attached between inferior pharyngeal constrictor and thyroid cartilage
What is the name of the superior pharyngeal constrictor’s inferior fibers that attach to the tongue base?
Glossopharyngeous muscle
2 possible functions of glossopharyngeous muscle
- tongue base retractuion
- Simultaneous anterior bulging of the posterior pharyngeal wall (PPW) at tongue base level
What is the name of the inferior structure muscle of the pharynx?
Cricopharyngeal muscle
Function of the cricopharyngeal muscle? AND Because of its function people often say…
Function: contract to prevent air from entering the esophagus during respiration
Some say cricopharyngeal muscle fibers are part of the inferior pharyngeal constrictor
Structures within pharynx
- Constrictor muscles (superior, middle, and inferior)
- Longitudinal muscles (stylopharyngeus, palatopharyngeus, and salpingopharyngeus)
- Muscle fibers: glossopharyngeous muscle & cricopharyngeal muscle
- Pyriform sinuses
- Pharyngoesophageal segment
What are the pyriform sinuses
pear-shaped subsite of the hypopharynx located to the back sides of the laryngeal opening
Which stricture separates the pharynx/larynx from the esophagus?
Pharyngoesophageal segment (or UES)
The pharyngoesophageal segment is ofter refered to as?
The upper esophageal sphincter
Safety of the upper esophageal spincter?
Prevents back flow of food and liquid back into the pharynx
The upper esophageal sphincter is formed by?
-cricoid lamina
-cricopharyngeal muscle fibers
Where is the upper esophageal sphincter (or PES) located?
Between C5-C6 vertebrae
(~ 1cm below true VFs)
The upper esophageal sphincter is innervated by?
- Vagus nerve branches (pharyngoesophageal nerve, superior laryngeal nerve, and recurrent laryngeal nerve)
- Glossopharyngeal nerve
- Sympathetic nerve fibers
What happens when the upper esophageal sphincter relaxes?
It opens
(the pharynx/larynx and the esophagus move away, allowing bolus to propel through)
Function of upper esophageal sphincter
- neural relaxation causing it to open
- Generates high pressure between pharynx and esophagus to propel bolus through
- Resting state is closed to prevent back flow into pharynx or early entrance into esophagus
4 factors that influence the opening of the upper esophageal sphincter?
- neural relaxation (inhibition)
- neck position and rotation affect UES pressure
- bolus size and pressure (bigger bolus = earlier opening & longer open duration)
- hyoid motion (allows UES to move forward and open)
The esophagus is a?
A collapsed muscular tube (23-25cm long)
Esophagus is innervated by?
Vagus (X) nerve
Muscles of the lips (2)
-Orbicularis oris
-Buccinator
Sensory innervation of the lips
Trigeminal nerve and facial nerve
3 masticatory muscles
-Temporalis
-Masseter
-Medial and Lateral Pterygoid
Floor of mouth musculature
-Mylohyoid
-Geniohyoid
-Anterior and Posterior Belly of Digastric
What are natural cavities or spaces where food or liquid usually collects or remains after the swallow?
The palatine tonsils between the anterior and posterior arches, the anterior sulci, and the lateral sulci
The oral tongue is active during what events?
-Speech
-Oral stages of swallowing
What control is the tongue under?
-Oral tongue–> voluntary control
-Pharyngeal tongue–> involuntary control (to some degree can be placed under voluntary)
Salivary glands produce two kinds of fluids, what are they
- Viscid- thicker, mucus like fluid
- Serious fluid- thinner and more watery fluid
What structures form the posterior and lateral pharyngeal wall?
The pharyngeal constrictors (superior, medial, and inferior)
What structures form the anterior pharyngeal wall?
-Pterygoid plates on the sphenoid bone
-Soft palate
-Base of tongue
-Mandible
-Hyoid bone
-Thyroid cartilage
-Cricoid cartilage
Fill in the structure:
The inferior constrictor attaches to the sides of the thyroid cartilage & forms _____ on each side extending down to the cricopharyngeal muscle
Pyriform sinuses
The anterior tilt of the thyroarytenoid muscle fibers contribute to what?
Airway entrance closure
Where are the false vocal folds located?
Superior, but parallel with the true vocal folds
The space formed between the false and true vocal folds on each side is called?
Laryngeal ventricle
The true vocal folds are composed of?
Vocalis muscle
Thyroarytenoid muscle
Vocal process of the arytenoids
The true vocal folds serve what important function
The last level of airway protection before entering the trachea
What are the three level of sphincter in the larynx?
Level 1: epiglottis and aryepiglottic folds
Level 2: arytenoids, base of epiglottis, and false vocal folds
Level 3; true vocal folds
Function of the 3 levels of the larynx sphincter
Completely close the larynx from the pharynx
Prevent penetration of food or liquid during swallowing
There is a close anatomic relationship between what structures?
-Floor of mouth
-Tongue
-Hyoid
-Larynx
