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Dysphagia > Anatomy of Swallowing > Flashcards

Anatomy of Swallowing Flashcards

1
Q

Role of UES:

A

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

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2
Q

What are older normal swallowing A&P variations?

A
  1. ossification of cartilages and hyoid bone.
  2. Pharyngeal swallow triggered when bolus head
    reaches middle of tongue base.
  3. 70+ larynx lower
  4. Arthritis in C- Vertebrae, impinge on pharyngeal wall.
  5. “Dippers”
  6. Delay, residue, penetrations
  7. reduced Hyolaryngeal excursion. Plateaus at CP
    Opening.
  8. Reduced CP Opening flexibility.
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3
Q

Esophageal Stage:

A

(8-20 seconds)

  • transit time measured from UES through LES
  • Bolus flow through the esophagus via peristaltic contractions of striated and smooth muscle along esophageal wall.
  • relaxation of LES allows bolus to flows into the stomach.
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4
Q

What are the 2 layers of muscle in the esophagus?

A
  1. Inner Circular
  2. Outer Longitudinal
    * made of striated and smooth muscle
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5
Q

What is CPG? Where is it ?

A

Central pattern generator of swallowing; located in medulla (in brainstem)
*This allows us not to think about swallowing.

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6
Q

Role of Thyroarytenoids:

A

attached thyroid cartilage to arytenoid, tilts arytenoid anteriorly during swallow to assist with airway closure

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7
Q

CN and Sensory or Motor?

-taste; anterior 2/3 of tongue?

A

Facial (VII); Afferent (sensory)

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8
Q

What are the pharyngeal structures?

A
  1. Pterygoid plates on sphenoid bone (nasopharynx)
  2. velum (oropharynx)
  3. tongue base
  4. mandible
  5. hyoid bone
  6. pharynx! (Pharyngeal walls)
  7. Epiglottis
  8. Thyroid Cartilage
  9. Cricoid Cartilage
  10. Vallecula/ ae
  11. Pyriform Sinuses
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9
Q

3 Laryngeal Strap Muscles?

A
  1. Thyrohyoid
  2. Sternothyroid
  3. Sternohyoid
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10
Q

CN and Sensory or Motor?

-Mastication

A

Trigeminal V (Motor)

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11
Q

What are the oral structures?

A
  1. Lips
  2. Teeth (24 deciduous, 32 permanent)
  3. Maxilla (Hard Palate)
  4. Velum (Soft Palate-shared with Oropharynx)
  5. Uvula
  6. Mandible
  7. Floor of Mouth
  8. Tongue (all but base)
  9. Faucial Arches- Anterior and Posterior
    10 Palatine Tonsils
  10. Sulcis-Anterior and Lateral
  11. Salivary Glands- parotid, submandibular, sublingual
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12
Q

What 2 muscles form the roof of the mouth?

A
  1. Palatoglossus

2. Palatopharyngeus

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13
Q

What are the pharyngeal/laryngeal muscles of swallowing?

A
  1. Suprahyoids/ Submittals
  2. Infrahyoids- thyrohyoid
  3. Constrictors
  4. Cricopharyngeus (CP)
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14
Q

What is an Apneic Period? When does it occur?

A 
-Occurs during pharyngeal stage
Lasts about 1 second. 
-increases as volume increases. 
-occurs mostly during exhalation (at or near end)
    - safer than during inhalation 
     - dysphagia> inhalation
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15
Q

Role of Interarytenoid:

A

attaches 2 arytenoids; adducts arytenoids/vocal folds

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16
Q

CN and Sensory or Motor?

-Uvula, palate, pharyngeal constrictors

A

Accessory XI (Motor)

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17
Q

CN and Sensory or Motor?

-Sensation, mucous membranes of pharynx, palate, posterior tongue, and tonsils

A

Vagus X; Afferent (sensory)

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18
Q

CN and Sensory or Motor?

-Taste and Sensation posterior 1/3 of tongue.

A

Glossopharyngeal (IX)

19
Q

CN and Sensory or Motor?

-Pharynx, gag reflex

A

Glossopharyngeal IX (Motor)

20
Q

CN and Sensory or Motor?

-Trachea, Larynx, Cough reflex

A

Vagus X (Motor)

21
Q

What is the cricopharyngeus muscle?

A

Inferior constrictor fibers are attached to the cricoid lamina; prevents air from entering the esophagus, reduces back flow.
*tonic at rest (when awake); divides pharynx and esophagus

22
Q

What are the laryngeal muscles of swallowing?

A
  1. PCA
  2. LCA
  3. TA
  4. Laryngeal strap muscles
23
Q

Role of Thyrohyoid ?

A

attaches thyroid cartilage to hyoid bone; elevates and lowers larynx.

24
Q

What are the pharyngeal/laryngeal muscles of swallowing?

Constrictors

A

Superior, Middle, Inferior > Posterior and Lateral Walls

25
Q

Oral Prep/Oral stage of dysphagia

A

(Time varies with bolus consistency)
-Labial m., lingual movement, sensory receptors, buccal m., nose breathing,

-mastication-rotary lateral mvmt. of jaw and tongue
-bolus formation: tongue mixes bolus with saliva
- “tipper” or “dipper”
-Bolus transport- tongue’s posterior movement of bolus
from oral cavity to pharynx.

(increase viscosity=decreased volume=increased pressure =increased muscle activity
-multiple swallows-

26
Q

What are the pharyngeal/laryngeal muscles of swallowing?

Infra hyoids-

A

thyrohyoid

27
Q

Role of LCA (Lateral Cricoarytenoid)

A

Attaches cricoid cartilage to arytenoid; adducts arytenoids/vocal folds

28
Q

What does the Palatopharyngeus do?

A

-in posterior faucial arch; helps elevate and retract velum (VP Closure)

29
Q

What are the laryngeal structures of swallowing?

A
  1. Hyoid Bone
  2. Epiglottis
  3. Valleculae
  4. Laryngeal Vestibule
  5. Aryepiglottic Folds> Lateral Vestibule Walls
  6. Thyroid Cartilage
  7. Arytenoid Cartilage
  8. False VFs
  9. True VFs
  10. Ventricles-lateral
30
Q

Pharyngeal Stages of Dysphagia (~1 second)

A

a. ) velum elevates and retracts for VP Closure, bolus transports with tongue base retraction, & pharyngeal wall contraction
b. ) epiglottis inverts, hyolaryngeal elevation and retraction
c. ) closure of larynx
d. CP openings
e. ) Transport by pharyngeal constrictors
f. ) CP Closure; larynx rests

31
Q

What are the pharyngeal/laryngeal muscles of swallowing?

Supra hyoids/Submentals

A

-mylohyoids, geniohyoids, digastrics (ant. belly)

32
Q

Role of LES:

A

-Keeps contents in stomach

33
Q

What are the oral intrinsic tongue muscles?

A
  1. Superior Longitudinal
  2. Inferior Longitudinal
  3. Transverse
  4. Vertical (alter shape)
34
Q

What are the 3 esophageal structures?

A 
1. UES (Upper Esophageal Sphincter) 
   (aka the Cricopharyngeus ) & PE Segment     
   (pharyngoesophageal sphincter 
2. Esophagus (~25 CM Long)
3. LES (Lower Esophageal sphincter )
35
Q

Role of Sternothyroid:

A

attaches sternum to thyroid; suspends larynx and trachea in neck.

36
Q

What are young normal swallowing A&P Vatiations?

A
  1. Hyoid and larynx are higher. ( more protection) less elevation
  2. Lower velum, shorter pharynx
  3. Uvula in epiglottis, pocketing valleculae
  4. Pharyngeal Swallow is triggered at anterior faucial arch. (bolus flow uninterrupted, no pause)
37
Q

What are the oral extrinsic tongue muscles?

A
  1. Genioglossus
  2. Hyoglossus
  3. Styloglossus
  4. Palatoglossus (protrude/retract, elevate/depress)
38
Q

CN and Sensory or Motor?

-Tongue

A

Hypoglossal XII (motor)

39
Q

What does the palatoglossus do?

A

-in anterior facial arch; pulls velum down and forward against back of the tongue

40
Q

CN and Sensory or Motor?

-Lips, Face, Salivary Glands,

A

Facial VII (Motor)

41
Q

CN and Sensory or Motor?

-sensation anterior 2/3 of tongue

A

Trigeminal (V); Afferent (sensory)

42
Q

Neurologic Swallowing A&P Variations?

A

pharyngeal swallow triggered when bolus head reaches middle of tongue base or falls into pyriforms.

43
Q

Role of Sternohyoid:

A

attaches sternum to hyoid, lowers and stabilizes hyoid

44
Q

Role of PCA (Posterior Cricoarytenoid)

A

attaches cricoid lamina to arytenoid; abducts arytenoids/vocal folds for respiration at end of swallow..

Dysphagia (7 decks)

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