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
2
Q
Name the salivary glands involved in swallowing.
A
- parotid
- submandibular
- sublingual
3
Q
What are the intrinsic tongue muscles involved in swallowing?
A
- superior longitudinal
- inferior longitudinal
- transverse
- vertical (alter shape)
4
Q
What are the extrinsic tongue muscles involved in swallowing?
A
- genioglossus
- hyoglosuss
- styloglossus
- palatoglossus
5
Q
What is the function of the genioglossus?
A
Protracts tongue
6
Q
What is the function of the hyoglossus?
A
Depresses tongue
7
Q
What is the function of the styloglossus?
A
Retracts and elevates tongue
8
Q
What is the function of the palatoglossus?
A
Pulls velum down & forward against back of tongue (elevates posterior tongue)
9
Q
Which muscle protracts the tongue?
A
Genioglossus
10
Q
Which muscle depresses the tongue?
A
hyoglossus
11
Q
Which muscle retracts and elevates the tongue?
A
styloglossus
12
Q
Which muscle pulls velum down & forward against back of tongue (elevates posterior tongue)?
A
palatoglossus
13
Q
What are the muscles involved on the roof of the mouth?
A
- palatoglossus
- palatopharyngeus
14
Q
What is the function of the palatopharyngeus muscle?
A
Helps elevate & retract velum (VP closure)
15
Q
Where is the palatoglossus muscle located on the roof of the mouth?
A
Anterior faucial arch
16
Q
Where is the palatopharyngeus muscle located on teh roof of the mouth?
A
Posterior faucial arch
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
18
Q
What are the pharyngeal/laryngeal muscles involved in swallowing?
A
- suprahyoids/submentals
- infrahyoid
- constrictors
- cricopharyngeus
19
Q
Name the suprahyoid/submental muscles involved in swallowing.
A
- Mylohyoids
- geniohyoids
- digastrics (anterior belly)
20
Q
Name the infrahyoid muscle (pharyngeal/laryngeal) involved in swallowing.
A
Thyrohyoid
21
Q
What are the constrictor muscles invovled in swallwoing?
A
- Superior
- Middle
- inferior: posterior & lateral walls
22
Q
What is the function of the cricopharyngeus muscle?
A
Prevents air from entering esophagus, reduces backflow
23
Q
The Cricopharyngeus muscle has ______ constrictor fibers attached to ______ ______.
A
inferior
cricoid lamina
24
Q
The cricopharyngeus muscle is _____ at rest (when awake).
A
tonic
25
What does the cricopharyngeus muscle devide?
pharynx and esophagus
26
What has to open to let the bolus thru the esophagus?
UES
27
The sphincter muscles are under _____ control.
involuntary
28
What happens to the sphincter muscles when they are at rest?
They contract; close.
29
What happens to the sphincter muscles when they activate?
They relax; open.
30
What is the function of the mylohyoid muscle?
Elevates hyoid bone and raises floor of mouth
31
What is the function of the geniohyoid muscle?
Elevates and protracts hyoid bone.
32
Which muscle elevates hyoid bone and raises floor of mouth?
mylohyoid muscle
33
Which muscle elevates and protracts the hyoid bone?
Geniohyoid
34
Look at the mylohyoid muscle on power point.
Book pg. 18
35
Look at the genyohyoid muscle on power point.
Google.
36
What is the function of the anterior belly of the digastric muscle?
Elevates hyoid bone.
37
Look for the anterior belly of the digastric muscle on power point.
Google
38
What is the function of the thyrohyoid muscle?
elevates and lowers the larynx
39
Which muscle elevates and lowers the larynx?
Thyrohyoid muscle
40
Which muscles elevate the hyoid bone?
- mylohyoids
- anterior belly of digastric
- geniohyoids
41
Look for thyrohyoid on power point.
Google.
42
What are the 10 laryngeal structures involved in swallowing?
- Hyoid bone
- epiglottis
- valleculae
- laryngeal vestibule
- aryepiglottic folds>lateral vestibule walls
- thyroid cartilage
- arytenoid cartilages
- false vocal folds
- true vocal folds
- ventricles-lateral
43
Name the laryngeal muscles that we should all know by heart by now.
- Posterior cricoarytenoid (PCA)
- Lateral cricoarytenoid (LCA)
- Interarytenoid
- Thyroarytenoid (thyromuscularis & thyrovocalis)
44
Name the laryngeal strap muscles.
- Thyrohyoid
- Sternothyroid
- Sternohyoid
45
What is the function of the PCA muscle?
Abducts arytenoids/vocal folds for respiration at end of swallow.
46
What is the function of the LCA muscle?
Adducts arytenoids/vocal folds
47
What is the function of the interarytenoid muscles?
Adducts arytenoids/vocal folds
48
What is the function of the thyroarytenoid muscle?
Tilts arytenoids anteriorly during swallow to assist with airway closure.
49
What is the function of the thyrohyoid muscle?
Elevates and lowers the larynx
50
What is the function of the sternothyroid muscle?
Suspends larynx & trachea in neck
51
What is the function of the sternohyoid muscle?
Lowers & stabilizes the hyoid bone
52
Which muscle suspends larynx and trachea in neck?
Sternothyroid muscle
53
Which muscle lowers and stabilizes the hyoid bone?
Sternohyoid muscle
54
What are the esophageal structures involved in swallowing?
- Upper esophageal sphincter (UES)
- Esophagus (25 cm long)
- Lower esophageal Sphincter (LES)
55
What does UES consist of?
-Cricopharyngeus
-Pharyngoesophageal sphincter (PE segment)
-
56
What are the esophageal muscles involved in swallowing?
- UES
- LES
- 2 layers of muscle in esophagus
- --------inner circular
- --------outer longitudinal
57
What is the function of the UES?
Keeps air out of esophagus, keeps contents swallowed from coming back up.
58
What is the function of the LES?
Keeps contents in stomach
59
What are the two layers of muscle in the esophagus (striated and smooth muscle)?
- Inner circular
| - Outer longitudinal
60
What components are important during the oral stage of swallowing?
- -labial muscle
- lingual movement
- sensory receptors
- buccal muscle
- nose breathing
61
What are the steps involved in the oral stage of swallowing?
- mastication
- bolus formation
- bolus transport
62
What is involved in mastication?
Rotary lateral movement of jaw and tongue.
63
What is involved in bolus formation?
tongue mixes bolus with saliva
64
What is involved in the transport of the bolus?
-tongue's posterior movement of bolus from the oral cavity to the pharynx.
65
What is valleculae?
Little pockets above and on the side of the epiglottis.
66
What is the function of the valleculae?
They can fill up in premature spilling. They fill up so it won't go into larynx.
67
Where is the laryngeal vestibule located?
From epiglottis down to vocal folds.
68
What are the components in bolus transport?
- high viscosity = low volume =high pressure = increased muscle activity
- multiple swallows
69
What are the lines of defense in swallowing?
1) Epiglottis
| 2) vocal folds
70
What happens to the vocal folds when we swallow?
adduct
71
What did the Dodds research conclude about normal healthy swallowing?
96% are tippers
72
What did the Dodds research conculde about patients with dysphagia?
90% are dippers
73
What was the overall conclusion about the Dodds research of tippers or dippers?
Tongue tipping helps move bolus back and create pharyngeal pressure. Tongue motions needs to be worked on.
74
When does a delayed pharyngeal swallow occur?
If pharyngeal stage not triggered when bolus head passes between faucial arches and tongue base.
75
When does the pharyngeal stage start in healthy swallowers?
Head of bolus touches anterior faucial pillars.
76
Delayed pharyngeal swallow occurs often with what population?
elderly
77
What is the duration of the esophageal stage?
8-20 seconds
78
How is transit time measured in the esophageal stage?
From UES through LES
79
When is aspiration normal?
Aspiration is never normal.
80
What happens with relaxation of LES?
Allows bolus to flow into the stomach.
81
What allows the bolus to flow into the stomach?
The relaxation of the LES
82
How does the bolus flow through the esophagus?
The bolus flows via peristaltic contraction of striated and smooth muscle along the esophageal wall.
83
What are the peristaltic contractions responsible for during the esophageal stage?
Bolus flow through the esophagus
84
Describe the esophageal stage.
- 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
What are pyriforms?
cavities behind the larynx
86
When is the pharyngeal swallow triggered (neurologic)?
When the head of the bolus head reaches middle of tongue base of when it falls into pyriforms.
87
Young patients are not as susceptible to _______ as the elderly.
penetration
88
List the anatomy variations in young normal people.
- 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
When is the pharyngeal swallow triggered in young normal people?
At anterior faucual arch (bolus flow uninterrupted, no pause)
90
When is the pharyngeal swallow triggered in normal elderly people?
When bolus head reaches middle of tongue base
91
What are anatomy characteristic of swallowing in normal elderly people?
- 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
How long is the apneic period?
Less than one second
93
When does the apneic period occur?
During the pharyngeal stage
94
The apneic period increases as what else increases?
volume
95
Does the apneic period occur during exhalation or inhalation?
Mostly during exhalation (at end or near end)
96
Why does the apneic period occur during exhalation?
It is safer than inhalation. If it happens in inhalation, dysphagia occurs.
97
Look at cortical control slide on power point.
Volitional vs reflexive
98
Which cranial nerves are responsible for motor (efferenc) control of swallowing?
- Trigeminal (V)
- Facial (VII)
- Hypoglossal (XII)
- Glossopharyngeal (IX)
- Vagus (X)
- Accessory (XI)
99
What is the function of the trigeminal nerve (V)?
Motor: Mastication
Sensory: sensation anterior 2/3 of tongue
100
What is the function of the facial nerve (VII)?
Motor: lips, face, salivary glands
Sensory: Taste anterior 2/3 of tongue
101
What is the function of the hypoglossal nerve (XII)?
Motor: tongue
sensory: sensation, mucous membranes of pharynx, palate, posterior tongue & tonsils
102
What is the function of the glossopharyngeal nerve (IX)?
Motor: movement of pharynx, gag reflex
| Sensory (afferent): taste & sensation of posterior 1/3 of tongue
103
What is the function of the vagus nerve?
Motor: trachea, larynx, pharynx, cough reflex
Sensory: mucous membrane of pharynx, larynx, bronchi, lungs, esophagus, stomach.
104
What is the function of the accessory (XI) nerve?
Motor: uvula, palate, pharyngeal constrictors
105
What are the cranial nerves involved in sensory (afferent) in swallowing?
- facial nerve
- Trigeminal
- Vagus nerve
- hypoglossal
- glossopharyngeal
