CHAPTER 100 MECHANISMS OF NORMAL AND ABNORMAL SWALLOWING

Question 1

Stages of Normal Deglutition (4)

Answer 1

1. Oral Preparatory Stage
2. Oral Stage
3. Pharyngeal Stage
4. Esophageal Stage

Question 2

Oral Preparatory Stage Steps:

Answer 2

1. Lip closure to hold food in mouth anteriorly
2. Tension in labial and buccal musculature to close anterior and lateral sulci
3. rotary motion of jaw for chewing
4. lateral rolling motion of tongue to position food on the teeth during mastication
5. bulging forward of the soft palate to seal the oral cavity posteriorly and widen the nasal airway

Question 3

Most important neuromuscular function involved in the oral PREPARATORY phase

Answer 3

Lateral rolling motion of the tongue

Question 4

Most critical element in ORAL stage of swallowing

Answer 4

Tongue motion

Question 5

Pharyngeal swallow is triggered by this nerve.

Answer 5

Glossopharyngeal nerve (CN IX)

Question 6

Aside from CN IX, this nerve also triggers the pharyngeal swallow at the inlet of the larynx.

Answer 6

Superior laryngeal nerve. Normal swallowing does not use this secondary mechanism for triggering the pharyngeal swallow, because food would have almost entered the airway by the time the pharyngeal swallow was triggered.

Question 7

Pharyngeal stage of swallow is more physiologically important than other phases of swallowing because:

Answer 7

Airway protection occurs during this stage in healthy people.

Question 8

Methods by which the oral preparatory and oral stages the swallow may be bypassed. (3)

Answer 8

1. reducing consistency of food to liquid
2. syringing food into the back of the mouth
3. positioning head back

Question 9

Steps involved in pharyngeal swallow: (5)

Answer 9

1. velopharyngeal closure - to prevent backflow up the nose
2. tongue base retraction to propel bolus through the pharynx
3. pharyngeal contraction to clear residue through the pharynx
4. airway protection, which involves both elevation and closure of the larynx
5. cricopharyngeal or upper esophageal sphincter opening to allow bolus to pass into the esophagus

Question 10

First responses to triggering the pharyngeal swallow (1)

Answer 10

1. velopharyngeal closure

2. hyoid and laryngeal elevation

Question 11

Responses to pharyngeal swallow (in order) - 4)

Answer 11

velopharyngeal closure and hyoid and laryngeal elevation –> laryngeal closure –> opening of cricopharyngeal sphincter

Question 12

Two dimensions involved in airway protection:

Answer 12

Elevation

Closure of larynx

Question 13

Three sphincters involved in laryngeal closure:

Answer 13

1. epiglottis and aryepiglottic folds
2. false vocal folds and airway entrance
3. true vocal folds

Question 14

Most important level of closure:

Answer 14

airway entrance closure

Question 15

PHARYNGEAL PRESSURE GENERATION:

When residue material remains in the valleculae after the swallow, it is interpreted as a symptom of:

Answer 15

Reduced Tongue - Base movement

Question 16

Purposes of the pharyngeal stage of swallow (2):

Answer 16

1. TRANSIT of material into the esophagus

2. AIRWAY PROTECTION - most important aspect of deglutition