Chapter 2 Flashcards
What are the structures of the oral phase?
Lips Teeth Maxilla (hard palate) Velum (soft palate) – shared with oropharynx Uvula Mandible Floor of mouth Tongue (all but base) Faucial arches - anterior & posterior Palatine tonsils Sulci - anterior & lateral Salivary glands
What are the three salivary glands?
parotid, submandibular, sublingual
Where does the oral tongue end?
at the circumvallate papillae
What are the intrinsic muscles of the tongue (oral)?
superior longitudinal, inferior longitudinal, transverse, vertical (alter shape)
What are the extrinsic muscles of the tongue (oral)?
genioglossus, hyoglossus, styloglossus, palatoglossus (protrude/retract, elevate/depress)
What are the structures of the pharyngeal phase?
Pterygoid plates on sphenoid bone- (nasopharynx) Velum (oropharynx) Tongue base Mandible Hyoid bone Pharynx! (pharyngeal walls) Epiglottis Thyroid cartilage Cricoid cartilage Vallecula (plural is valleculae) Pyriform sinuses
What are the muscles of the roof of the mouth (Oral)?
Palatoglossus and Palatopharyngeus
What does the palatoglossus do and where is it located?
in anterior faucial arch and it pulls the velum down and forward against the back of tongue
What does the palatopharyngeus do and where is it located?
in posterior faucial arch and it helps elevate & retract velum (VP closure)
What are the muscles in pharyngeal/laryngeal phase?
Suprahyoids/submental
Infrahyoid
Contrictors
Cricopharyngeus (CP)
What are the muscles within the suprahyoids (pharyngeal)?
mylohyoids
geniohyoids
digastrics (anterior belly)
What is the muscle within the infrahyoid (pharyngeal)?
thyrohyoid
What are the muscles within the constrictors (pharyngeal)?
Superior, Middle, Inferior
Posterior & lateral walls
The CP inferior constrictor fibers attach to
cricoid lamina
What is the CP’s job?
to prevent air from entering esophagus, reduces backflow
The CP is __ at rest (when awake) and __ when activated
tonic (tight)
loose/long
The CP divides the
pharynx and esophagus
What are the structures of the larynx?
Hyoid Bone Epiglottis Valleculae Laryngeal vestibule Aryepiglottic folds > lateral vestibule walls Thyroid cartilage Arytenoid cartilages False vocal folds True vocal folds Ventricles – lateral
What are the Laryngeal muscles?
PCA (posterior cricoarytenoid) LCA (lateral cricoarytenoid) Interarytenoid TA (thyroarytenoid) Laryngeal strap muscles
What does the PCA attach and what is its purpose?
attaches the cricoid lamina to arytenoid
and it abducts arytenoids/vocal folds for respiration at the end of swallow
What does the LCA attach and what is its purpose?
attaches cricoid cartilages to arytenoid
and it adducts arytenoids/vocal folds
What do the Interarytenoid attach and what is its purpose?
it attaches 2 arytenoids
and adducts arytenoids/vocal folds
What does the TA attach and what is its purpose?
attaches thyroid cartilage to arytenoid
and it tilts arytenoids anteriorly during swallow to assist with airway closure
What are the laryngeal strap muscles?
Thyrohyoid
Sternothyroid
Sternohyoid
Laryngeal Strap muscles
What does the thyrohyoid attach and what is its purpose?
it attaches thyroid cartilage to hyoid bone
and it elevates and lowers larynx
Laryngeal Strap muscles
What does the sternothyroid attach and what is its purpose?
it attaches the sternum to the thyroid cartilage
and it suspends larynx & trachea in neck
Laryngeal Strap muscles
What does the sternohyoid attach and what is its purpose?
it attaches the sternum to the hyoid
and it lowers and stabilizes hyoid
What are the structures of esophageal phase?
UES
Esophagus
LES
What are other names for the UES?
CP (cricopharyngeus)
PE or PES segment (pharyngoesophageal sphincter)
The UES can also be part of the
Pharyngeal phase structures
How long is the esophagus?
~25 cm or 9 in
What are the muscles of the esophageal phase?
UES
LES
2 layers of muscle in esophagus
What is the purpose of the UES?
keeps air out of lungs, keeps contents swallowed from coming back up
What is the purpose of the LES?
keeps contents in stomach
What are the 2 layers of muscle in esophagus?
inner circular and outer longitudinal which are both striated and smooth muscle
What is the purpose of the inner circular and outer longitudinal muscles?
help with peristaltic contractions to move food down
What is the first line of defense against aspiration?
epiglottis
What is the second line of defense against aspiration?
Vocal folds
What are the stages of dysphagia?
oral, pharyngeal and esophageal
Describe the what is involved in the oral stage?
labial muscle, labial movement, sensory receptors, buccal muscle and nose breathing
Describe the oral stage steps
mastication
bolus formation
tipper or dipper
bolus transport from oral cavity to the pharynx
The dysphagia population are known to be __
dippers
What happens in the mastication step in the oral stage?
rotary lateral movement of jaw and tongue
What happens in the bolus formation step in the oral stage?
the tongue mixes bolus with saliva
When the bolus is transported from oral cavity to pharynx in the oral stage, what propels the movement of the bolus?
the tongue’s posterior movement
What are the steps of the pharyngeal phase?
- the velum elevates and retracts for VP closure, bolus transport with tongue base retraction and pharyngeal wall contraction
- epiglottis inverts, hyolaryngeal elevation and protraction
- closure of larynx
- CP opening
- Transport by pharyngeal constrictors
- CP closure, larynx resets
What are the steps of the esophageal phase?
- transit time is measure 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 stomach
What are some characteristics of a normal swallow in a young person?
- Higher hyoid and larynx, less elevation
- lower velum, shorter pharynx
- uvula in epiglottis, pocketing valleculae
- pharyngeal swallow is triggered at anterior faucial arch
- the bolus flow is uninterrupted, no pauses
Why do young children have move protection?
because their structures are very compressed and leaves little room for things to go wrong
What are some characteristics of a normal swallow in an older person?
- ossification of cartilages and hyoid bone
- pharyngeal swallow triggered when bolus head reaches middle of tongue base
- they can normally have delayed pharyngeal swallow and spillage
- 70+ larynx lower
- arthritis in C vertebrae impinge on pharyngeal wall
- primarily ‘dippers’
- delay, residue, penetration are normal
- reduced hyolaryngeal excursion, plateaus at CP opening
- reduced CP opening flexibility
What are some characteristics of the swallow of a patient with neurologic issues?
- pharyngeal swallow triggered when bolus head reaches the middle of the tongue base or when it falls into pyriforms
- delays
- they often aspirate
What is never normal in any swallow?
aspiration
Sensory for Trigeminal (V)
sensation anterior 2/3 of tongue
Sensory for Facial (VII)
taste anterior 2/3 of tongue
Sensory for Hypoglossal (XII)
Sensation, mucous membranes of pharynx, palate, posterior tongue and tonsils
Sensory for Vagus (X)
*Most important
Mucous membrane of pharynx, larynx, bronchi, lungs, esophagus, stomach
Sensory for Glossopharyngeal (IX)
Taste and sensation of posterior 1/3 of tongue
Motor for Trigeminal (V)
mastication
Motor for Facial (VII)
lips, face, salivary glands
Motor for Hypoglossal (XII)
tongue
Motor for Glossopharyngeal (IX)
pharynx, gag reflex
Motor for Vagus (X)
trachea, larynx, pharynx, cough reflex
Motor for Accessory (XI)
Uvula, palate, pharyngeal constrictors (because of location)
What is the Apneic Period?
it happens during pharyngeal stage
it increases as bolus increases
mostly during exhalation (at end or near end)
How long does the apneic period last?
~1 second
Why is it safer for the apneic period to be on exhalation instead of inspiration?
because the airway is better protected
The VFs close for protection
What is dysphnea?
problems with breathing
Is it necessary to have an apneic period?
yes, there are problems when there is no apneic period
As viscosity of the bolus increases then volume __ and pressure __ which leads to __ muscle activity pharyngeally
decreases, increases, increased
Is it ok to have multiple swallows?
yes, it is actually a therapy technique
What cranial nerves provide sensory information during the pharyngeal swallow?
IX (glossopharyngeal) X (vagus) XI (accessory) XII (hypoglossal) VII (facial) V (trigeminal)
What cranial nerves provide motor information during the pharyngeal swallow?
XI (accessory)
X (vagus)
What two structures should make complete contact at the tail of the bolus to create pressure during pharyngeal phase?
tongue base and pharygeal walls
What two structures move simultaneously during pharyngeal phase?
VP closure and hylolaryngeal upward and forward movement
___ opens and the __ closes simultaneously
UES; airway
Can the UES be under voluntary control?
yes, patients can be taught to voluntarily protect their airway or to open the UES sphincter voluntarily
Is there a way to voluntarily initiate or modify the pharyngeal wall constriction?
No
Patients with esophageal phases disorders should be referred to __
gastroentrologist
What are the functions of the valves?
directing food, applying pressure and to propel it along
What are the names of the valves?
lips, oral tongue, vp sphincter, tongue base and pharyngeal wall, larynx (epiglottis, arytenoids, false vfs, vfs), UES, LES
Describe the oral tongue
it is for speech and used in the oral stage and is under voluntary control and ends and circumvallate papillae
Describe tongue base
involuntary control, starts at circumvallate papillae and extends to hyoid bone
The UES is a __ valve
muscoskeletal
The LES is a __ spincter
muscular
What do dysphagic patients do in reference to breathing that increases their risk of aspiration?
they often interrupt inhalation to swallow
What happens when you are drinking from a cup?
early airway closure and some pre elevation of larynx as cup is approaching lips
