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Dysphagia > Anatomy of swallowing > Flashcards

Anatomy of swallowing Flashcards

1
Q

What are the (12) oral structures involved in swallowing?

A
  • lips
  • teeth
  • 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 & lateral
  • salivary glands: parotid, submandibular, sublingual
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2
Q

Name the salivary glands involved in swallowing.

A
  • parotid
  • submandibular
  • sublingual
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3
Q

What are the intrinsic tongue muscles involved in swallowing?

A
  • superior longitudinal
  • inferior longitudinal
  • transverse
  • vertical (alter shape)
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4
Q

What are the extrinsic tongue muscles involved in swallowing?

A
  • genioglossus
  • hyoglosuss
  • styloglossus
  • palatoglossus
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5
Q

What is the function of the genioglossus?

A

Protracts tongue

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6
Q

What is the function of the hyoglossus?

A

Depresses tongue

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7
Q

What is the function of the styloglossus?

A

Retracts and elevates tongue

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8
Q

What is the function of the palatoglossus?

A

Pulls velum down & forward against back of tongue (elevates posterior tongue)

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9
Q

Which muscle protracts the tongue?

A

Genioglossus

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10
Q

Which muscle depresses the tongue?

A

hyoglossus

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11
Q

Which muscle retracts and elevates the tongue?

A

styloglossus

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12
Q

Which muscle pulls velum down & forward against back of tongue (elevates posterior tongue)?

A

palatoglossus

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13
Q

What are the muscles involved on the roof of the mouth?

A
  • palatoglossus

- palatopharyngeus

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14
Q

What is the function of the palatopharyngeus muscle?

A

Helps elevate & retract velum (VP closure)

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15
Q

Where is the palatoglossus muscle located on the roof of the mouth?

A

Anterior faucial arch

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16
Q

Where is the palatopharyngeus muscle located on teh roof of the mouth?

A

Posterior faucial arch

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17
Q

Name the 11 pharyngeal structures involved in swallowing.

A
  • Pteroygoid plates on sphenoid bone (nasopharynx)
  • velum (oropharynx)
  • tongue base
  • mandible
  • hyoid bone
  • pharynx (pharyngeal walls)
  • epiglottis
  • thyroid cartilage
  • cricoid cartilage
  • vallecula
  • pryriform sinuses
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18
Q

What are the pharyngeal/laryngeal muscles involved in swallowing?

A
  • suprahyoids/submentals
  • infrahyoid
  • constrictors
  • cricopharyngeus
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19
Q

Name the suprahyoid/submental muscles involved in swallowing.

A
  • Mylohyoids
  • geniohyoids
  • digastrics (anterior belly)
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20
Q

Name the infrahyoid muscle (pharyngeal/laryngeal) involved in swallowing.

A

Thyrohyoid

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21
Q

What are the constrictor muscles invovled in swallwoing?

A
  • Superior
  • Middle
  • inferior: posterior & lateral walls
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22
Q

What is the function of the cricopharyngeus muscle?

A

Prevents air from entering esophagus, reduces backflow

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23
Q

The Cricopharyngeus muscle has ______ constrictor fibers attached to ______ ______.

A

inferior

cricoid lamina

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24
Q

The cricopharyngeus muscle is _____ at rest (when awake).

A

tonic

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25
Q

What does the cricopharyngeus muscle devide?

A

pharynx and esophagus

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26
Q

What has to open to let the bolus thru the esophagus?

A

UES

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27
Q

The sphincter muscles are under _____ control.

A

involuntary

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28
Q

What happens to the sphincter muscles when they are at rest?

A

They contract; close.

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29
Q

What happens to the sphincter muscles when they activate?

A

They relax; open.

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30
Q

What is the function of the mylohyoid muscle?

A

Elevates hyoid bone and raises floor of mouth

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31
Q

What is the function of the geniohyoid muscle?

A

Elevates and protracts hyoid bone.

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32
Q

Which muscle elevates hyoid bone and raises floor of mouth?

A

mylohyoid muscle

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33
Q

Which muscle elevates and protracts the hyoid bone?

A

Geniohyoid

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34
Q

Look at the mylohyoid muscle on power point.

A

Book pg. 18

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35
Q

Look at the genyohyoid muscle on power point.

A

Google.

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36
Q

What is the function of the anterior belly of the digastric muscle?

A

Elevates hyoid bone.

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37
Q

Look for the anterior belly of the digastric muscle on power point.

A

Google

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38
Q

What is the function of the thyrohyoid muscle?

A

elevates and lowers the larynx

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39
Q

Which muscle elevates and lowers the larynx?

A

Thyrohyoid muscle

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40
Q

Which muscles elevate the hyoid bone?

A
  • mylohyoids
  • anterior belly of digastric
  • geniohyoids
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41
Q

Look for thyrohyoid on power point.

A

Google.

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42
Q

What are the 10 laryngeal structures involved in swallowing?

A
  • Hyoid bone
  • epiglottis
  • valleculae
  • laryngeal vestibule
  • aryepiglottic folds>lateral vestibule walls
  • thyroid cartilage
  • arytenoid cartilages
  • false vocal folds
  • true vocal folds
  • ventricles-lateral
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43
Q

Name the laryngeal muscles that we should all know by heart by now.

A
  • Posterior cricoarytenoid (PCA)
  • Lateral cricoarytenoid (LCA)
  • Interarytenoid
  • Thyroarytenoid (thyromuscularis & thyrovocalis)
44
Q

Name the laryngeal strap muscles.

A
  • Thyrohyoid
  • Sternothyroid
  • Sternohyoid
45
Q

What is the function of the PCA muscle?

A

Abducts arytenoids/vocal folds for respiration at end of swallow.

46
Q

What is the function of the LCA muscle?

A

Adducts arytenoids/vocal folds

47
Q

What is the function of the interarytenoid muscles?

A

Adducts arytenoids/vocal folds

48
Q

What is the function of the thyroarytenoid muscle?

A

Tilts arytenoids anteriorly during swallow to assist with airway closure.

49
Q

What is the function of the thyrohyoid muscle?

A

Elevates and lowers the larynx

50
Q

What is the function of the sternothyroid muscle?

A

Suspends larynx & trachea in neck

51
Q

What is the function of the sternohyoid muscle?

A

Lowers & stabilizes the hyoid bone

52
Q

Which muscle suspends larynx and trachea in neck?

A

Sternothyroid muscle

53
Q

Which muscle lowers and stabilizes the hyoid bone?

A

Sternohyoid muscle

54
Q

What are the esophageal structures involved in swallowing?

A
  • Upper esophageal sphincter (UES)
  • Esophagus (25 cm long)
  • Lower esophageal Sphincter (LES)
55
Q

What does UES consist of?

A

-Cricopharyngeus
-Pharyngoesophageal sphincter (PE segment)
-

56
Q

What are the esophageal muscles involved in swallowing?

A
  • UES
  • LES
  • 2 layers of muscle in esophagus
  • ——–inner circular
  • ——–outer longitudinal
57
Q

What is the function of the UES?

A

Keeps air out of esophagus, keeps contents swallowed from coming back up.

58
Q

What is the function of the LES?

A

Keeps contents in stomach

59
Q

What are the two layers of muscle in the esophagus (striated and smooth muscle)?

A
  • Inner circular

- Outer longitudinal

60
Q

What components are important during the oral stage of swallowing?

A
  • -labial muscle
  • lingual movement
  • sensory receptors
  • buccal muscle
  • nose breathing
61
Q

What are the steps involved in the oral stage of swallowing?

A
  • mastication
  • bolus formation
  • bolus transport
62
Q

What is involved in mastication?

A

Rotary lateral movement of jaw and tongue.

63
Q

What is involved in bolus formation?

A

tongue mixes bolus with saliva

64
Q

What is involved in the transport of the bolus?

A

-tongue’s posterior movement of bolus from the oral cavity to the pharynx.

65
Q

What is valleculae?

A

Little pockets above and on the side of the epiglottis.

66
Q

What is the function of the valleculae?

A

They can fill up in premature spilling. They fill up so it won’t go into larynx.

67
Q

Where is the laryngeal vestibule located?

A

From epiglottis down to vocal folds.

68
Q

What are the components in bolus transport?

A
  • high viscosity = low volume =high pressure = increased muscle activity
  • multiple swallows
69
Q

What are the lines of defense in swallowing?

A

1) Epiglottis

2) vocal folds

70
Q

What happens to the vocal folds when we swallow?

A

adduct

71
Q

What did the Dodds research conclude about normal healthy swallowing?

A

96% are tippers

72
Q

What did the Dodds research conculde about patients with dysphagia?

A

90% are dippers

73
Q

What was the overall conclusion about the Dodds research of tippers or dippers?

A

Tongue tipping helps move bolus back and create pharyngeal pressure. Tongue motions needs to be worked on.

74
Q

When does a delayed pharyngeal swallow occur?

A

If pharyngeal stage not triggered when bolus head passes between faucial arches and tongue base.

75
Q

When does the pharyngeal stage start in healthy swallowers?

A

Head of bolus touches anterior faucial pillars.

76
Q

Delayed pharyngeal swallow occurs often with what population?

A

elderly

77
Q

What is the duration of the esophageal stage?

A

8-20 seconds

78
Q

How is transit time measured in the esophageal stage?

A

From UES through LES

79
Q

When is aspiration normal?

A

Aspiration is never normal.

80
Q

What happens with relaxation of LES?

A

Allows bolus to flow into the stomach.

81
Q

What allows the bolus to flow into the stomach?

A

The relaxation of the LES

82
Q

How does the bolus flow through the esophagus?

A

The bolus flows via peristaltic contraction of striated and smooth muscle along the esophageal wall.

83
Q

What are the peristaltic contractions responsible for during the esophageal stage?

A

Bolus flow through the esophagus

84
Q

Describe the esophageal stage.

A
  • transit time is measured from UES through LES
  • 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
85
Q

What are pyriforms?

A

cavities behind the larynx

86
Q

When is the pharyngeal swallow triggered (neurologic)?

A

When the head of the bolus head reaches middle of tongue base of when it falls into pyriforms.

87
Q

Young patients are not as susceptible to _______ as the elderly.

A

penetration

88
Q

List the anatomy variations in young normal people.

A
  • Higher hyoid & larynx (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).
89
Q

When is the pharyngeal swallow triggered in young normal people?

A

At anterior faucual arch (bolus flow uninterrupted, no pause)

90
Q

When is the pharyngeal swallow triggered in normal elderly people?

A

When bolus head reaches middle of tongue base

91
Q

What are anatomy characteristic of swallowing in normal elderly people?

A
  • ossification of cartilages & hyoid bone
  • pharyngeal swallow triggered when bolus head reaches middle of tongue base
  • 70 + larynx is lower
  • arthritis in C vertebrae impinge on pharyngeal wall
  • dippers
  • delay, residue, penetration
  • reduced hyolaryngeal excursion, plateaus at CP opening
  • Reduced CP opening flexibility
92
Q

How long is the apneic period?

A

Less than one second

93
Q

When does the apneic period occur?

A

During the pharyngeal stage

94
Q

The apneic period increases as what else increases?

A

volume

95
Q

Does the apneic period occur during exhalation or inhalation?

A

Mostly during exhalation (at end or near end)

96
Q

Why does the apneic period occur during exhalation?

A

It is safer than inhalation. If it happens in inhalation, dysphagia occurs.

97
Q

Look at cortical control slide on power point.

A

Volitional vs reflexive

98
Q

Which cranial nerves are responsible for motor (efferenc) control of swallowing?

A
  • Trigeminal (V)
  • Facial (VII)
  • Hypoglossal (XII)
  • Glossopharyngeal (IX)
  • Vagus (X)
  • Accessory (XI)
99
Q

What is the function of the trigeminal nerve (V)?

A

Motor: Mastication
Sensory: sensation anterior 2/3 of tongue

100
Q

What is the function of the facial nerve (VII)?

A

Motor: lips, face, salivary glands
Sensory: Taste anterior 2/3 of tongue

101
Q

What is the function of the hypoglossal nerve (XII)?

A

Motor: tongue
sensory: sensation, mucous membranes of pharynx, palate, posterior tongue & tonsils

102
Q

What is the function of the glossopharyngeal nerve (IX)?

A

Motor: movement of pharynx, gag reflex

Sensory (afferent): taste & sensation of posterior 1/3 of tongue

103
Q

What is the function of the vagus nerve?

A

Motor: trachea, larynx, pharynx, cough reflex
Sensory: mucous membrane of pharynx, larynx, bronchi, lungs, esophagus, stomach.

104
Q

What is the function of the accessory (XI) nerve?

A

Motor: uvula, palate, pharyngeal constrictors

105
Q

What are the cranial nerves involved in sensory (afferent) in swallowing?

A
  • facial nerve
  • Trigeminal
  • Vagus nerve
  • hypoglossal
  • glossopharyngeal

Dysphagia (4 decks)

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