Chapter 2 Anatomy Of Swallowing Flashcards
1
Q
List the surface features of the oral cavity and pharynx.
A
Anterior Boundary of the Oral Cavity:
- Lips & Teeth
Lateral Boundary of the Oral Cavity:
- The teeth & cheeks forming the lateral boundary
Superior Boundary of the Oral Cavity:
- Hard & soft palate
Midline at the Posterior Edge:
- With the uvula hanging midline at the posterior edge of the soft palate.
Lateral Posterior Boundary of the Oral Cavity:
- Faucial pillars, formed by the palatoglossal & palatopharyngeal folds.
- Epithelium is moistened by saliva, produced by salivary glands that line the oral cavity.
- In the mucosa of the floor of the mouth are found openings for the submandibular & sublingual glands.
- Openings of the parotid glands are found between the cheeks & upper molars.
- The entire oral cavity is innervated with somatosensory neurons that provide information about the temperature, volume, consistency & position of a bolus that is critical to effective swallowing.
2
Q
What are the various types of papillae on the surface of the tongue?
A
- Filiform
- Foliate
- Vallate
- Can be found that house many taste receptors
3
Q
What are the focal structures visualized in a videofluoroscopic study to assess the oral phase of swallowing?
A
The lips, tongue, and soft palate are focal structures visualized in a videofluoroscopic study to assess the oral phase of swallowing.
4
Q
What are the pharynx incorporates four portals or quadrivium into other conduits include?
A
- Oral cavity
- Nasal cavity
- Trachea
- Esophagus
5
Q
What is the pharynx connected to and integrates with?
A
- The pharynx is connected to and integrates with multiple skeletal elements, including bones & cartilage.
- The inner surface of the muscular pharynx is covered with a tough sheet of deep fascia called the pharyngobasilar fascia, a membrane that is lined with a continuous layer of mucosa.
- This mucosal lining drapes over the entire inner surface of the pharynx, including muscles, bone, & cartilage.
- This mucosal draping creates named spaces & folds.
6
Q
What are the 3 subdivision of the pharynx?
A
- Nasopharynx
- Oropharynx
- Laryngopharynx is more often clinically referred to as the hypopharynx.
7
Q
Where does the bolus passes through?
A
A bolus passes from the oral cavity through the oropharynx and hypopharynx to the esophagus.
8
Q
What spaces are most relevant to swallowing in the pharynx?
A
- The spaces most relevant to swallowing in the pharynx are the valleculae & the piriform recesses or sinuses.
- The valleculae or “little valley,” lie between the median & lateral glossoepiglottic folds & become a potential reservoir for pharyngeal residue.
- The other common sites for residue are the piriform recesses, spaces lateral to the larynx created by the mucosa draping from the laryngeal in let to the muscular pharyngeal wall on either side.
- When the pharynx is relaxed, residue can pool either piriform recess on the side of the upper esophagus sphincter.
9
Q
What are the additional folds that are formed by structures that lie within each pharyngeal folds?
A
- Median glossoepiglottic fold is formed by mucosa draping over the glossoepiglottic ligament.
- Aryepiglottic folds border the laryngeal vestibule & contain small variable muscle fascicles.
- The palatoglossal fold & palatopharyneal folds, formed by muscles with the same name, descend from the palate tonsil & are referred to as the anterior & posterior faucial pillar, respectively.
- Salpingopharyngeal fold forms around the salpingopharyngeal muscle, beginning at the opening of the auditory tube I the nasopharynx & extending inferiorly into the hypopharynx on the lateral pharyngeal walls.
10
Q
What are the subdivision anatomical, and it’s regions are of the pharynx?
A
Nasopharynx
- Opening into the choanae of the nasal cavity, is closed inferiorly by the soft palate or velum, and is bordered posteriorly and laterally by the pharyngeal walls.
Boundaries of the Oropharynx
- Are marked by the Oropharyngeal isthmus anteriorly, the velum (soft palate) superiorly, the epiglottis inferiorly, and the pharyngeal walls, posteriorly and laterally.
Border the Hypopharynx
- The epiglottis, laryngeal vestibule, esophagus, and pharyngeal walls, including the piriform recesses.
11
Q
What are the recognizable features of the Nasopharynx, Oropharynx, & Hypopharynx?
A
Oropharynx & Hypopharynx
- Include the soft palate, uvula, faucial pillars, palatine tonsils, laryngeal vestibule, upper esophageal sphincter, valleculae, and piriform recess.
- Features of the Nasopharynx are oriented around the opening to the auditory or pharyngotympanic tube.
12
Q
What are the tonsils and features?
A
Tubal tonsils
- Located on mucosa covering the opening of the auditory tube.
Pharyngeal tonsils, also called the adenoids
- Located posterior to the opening of the auditory tube.
- Enlarged adenoids can block both the nasal cavity & the auditory tube, leading to mouth breathing & problems in craniofacial development in children.
Palatine tonsils, often called tonsils
- Located inferior to the palate between the faucial pillars.
- All of these tonsils form a ring of lymphoid tissue (Waldeyer’s ring) surrounding the oral & nasal cavity portals to the pharynx, serving to protect the body from exogenous material.
- Severe inflammation of tonsils makes swallowing painful & difficult.
13
Q
What is the difference between the innervation of the pharynx & the mucosa covering of the larynx, & the laryngeal vestibule?
A
- The pharynx does not have the same degree of somatosensory innervation as the oral cavity.
- The mucosa covering the faucial arches, opening of the larynx & the laryngeal vestibule is densely innervated.
14
Q
What bones are connected to the proximal openings of the pharynx into the oral & nasal cavity?
A
The proximal openings of the pharynx into the oral & nasal cavity are connected to bones of the viscerocranium and cranial base.
15
Q
What bones are connected to the distal openings into the trachea & esophagus?
A
The distal openings into the trachea & esophagus connect to the hyolaryngeal complex.
16
Q
What does the oral cavity encompasses?
A
- The oral cavity encompasses the mandible, the maxilla, the teeth, & the palatine bone from which the soft palate extends posteriorly.
17
Q
Where are the teeth housed?
A
- Teeth are housed within the alveolar processes of the maxilla and mandible.
18
Q
What does the medial pterygoid plates serve as?
A
- The medial pterygoid plates serve as an attachment site for the superior and of the pharynx leading into the nasal cavity.
19
Q
What bones are all important cranial base attachments sites for muscles underlying mastication & swallowing?
A
- The pharyngeal tubercle of the occipital bone, the styloid process and mastoid process of temporal bone, and other surfaces of the temporal and sphenoid bones are all important cranial base attachment sites for muscles underlying mastication & swallowing.
20
Q
What is the hyolaryngeal complex composed of?
A
- The hyolaryngeal complex is composed of the hyoid bone, laryngeal cartilages, and associated structures.
21
Q
What are the 5 cartilages of the laryngeal skeleton composed primarily of?
A
- Thyroid
- Cricoid
- Paired arytenoids
- Epiglottis
22
Q
What attaches the epiglottis to the hyoid & thyroid cartilage?
A
- Ligaments attach the epiglottis to the hyoid and thyroid cartilage.
23
Q
What cartilages serve as important attachment sites for the inferior pharyngeal constrictor muscle connecting the pharynx & esophagus?
A
Of the laryngeal cartilages, the thyroid & cricoid cartilages serve as important attachment sites for the inferior pharyngeal constrictor muscle connecting the pharynx & esophagus.
24
Q
What are the dense ligaments that tether the thyroid cartilage to the hyoid, & the cricoid to the thyroid cartilages?
A
Dense ligaments tether the thyroid cartilage to the hyoid (called the thyrohyoid membrane), & the cricoid to the thyroid cartilages (called the cricothyroid ligament).
25
What are the valve function of the larynx primarily involves with?
The valve functions of the larynx primarily involves the arytenoid, cricoid, & thyroid cartilages.
26
What anchors the hyoid inferiorly attached to the posterior facet of the sternum & scapula?
Muscles anchoring the hyoid inferiorly attach to the posterior facet of the sternum & scapula.
27
In osteology, what is directly relevant to the functional swallowing apparatus included?
The osteology relevant to the functional swallowing apparatus includes the mandible, the hard palate (maxilla & the palatine bones), the medial pterygoid plates of the sphenoid, the styloid & mastoid process of the temporal bone, the temporomandibular joint, the hyoid & laryngeal cartilages (thyroid, cricoid, arytenoid, & epiglottis), & the sternum & scapulae.
28
What structure is visible in the anterior portion of the neck?
The larynx is a visible structure in the anterior portion of the neck.
29
Where is the larynx located?
The larynx is located in the most inferior portion of the pharynx, the hypopharynx, or laryngopharynx.
30
What are attached to the vocal folds and the muscles that accomplish movement of and within the larynx?
The vocal folds and the muscles that accomplish movement of and within this organ are attached to the laryngeal cartilages.
31
What laryngeal cartilages form a series of synovial joints?
The laryngeal cartilages that form a series of synovial joints are the cricothyroid joint, & the cricoarytenoid joints.
32
What does the cricothyroid joint allow?
The cricothyroid joint allows the cricoid cartilage to rotate around the thyroid cartilage, which shortens or lengthens the vocal folds.
33
What does the cricoarytenoid joints allow?
- Movement at the cricoarytenoid joints allows for the vocal folds sliding toward or away from each other.
- Also, the cricoarytenoid joints allows for anterior tilting of the vocal folds.
34
What other elements of the skeleton are indirectly relevant to swallowing, and are important dysphagia management?
- The cervical vertebrae, atlantoaxial joint, & atlantooccipital joint all lie within the prevertebral compartment of the neck.
- Muscles and bones in this compartment are primarily concerned with the position of the head and neck.
- Flexing and extending the head and neck or turning the head from one side to another changes the morphology of the pharynx and may add mechanical advantage to swallowing musculature.
35
How should the movement of the hyoid should be evaluated?
Although the hyoid appears to be related to the vertebrae, movement of the hyoid should be evaluated in relationship to the mandible to which it is attached, and not the vertebrae, to which it is not attached.
36
What is basicranium?
- The basicranium is the underside of the skull (not including the hard palate).
- It forms the base of the calvarium (brain case), & posterior portion of the pharynx.
- At birth, the basicranium shows a general flatness with no marked angulation, which is significantly different than the sharp angle seen in the adult basicranium.
- The lack of angulation in the infant basicranium is desirable for maintaining potency in the pharynx for respiration; however, it limits the verbalization potential for the infant by shortening the vocal tract.
- There is rapid change to the head and neck regions, due in large part to the rapid growth of the brain, during the first several years of life.
- This results in visible changes to the basicranium.
37
What structure is heavily influenced the shape of the hard palate?
- The forces generated by the tongue heavily influence the shape of the hard palate.
- A high-arched palate may be developmental feature, or it can be caused by chronic thumb sucking.
- This condition may contribute to a narrow airway and influence disordered breathing during sleep.
38
What are the muscles underlying ingestion and bolus formation include?
- Facial Muscles
- Muscles of Mastication
- Muscles of the Tongue
- These muscle groups work in concert to receive food or liquid into the oral cavity and to form a bolus in preparation for bolus transport.
39
What facial musculature that are relevant to feeding?
Muscles of the Circumoral Region
- Orbicularis Oris
- Buccinator
- Levator Labii Superioris
- Depressor Labii Inferioris
- Levator Anguli Oris
- Depressor Anguli Oris
- Mentalis
- Zygomaticus Major
- Zygomaticus Minor
40
How does feeding begins?
- Feeding begins with muscles of the face.
- The orbicularis oris lies deep to the lips in the superficial fascia of the face & is positioned by several muscles that converge on the lateral angle of the mouth, creating a mass called the modiolus.
- This sphincter closes the mouth & helps contain a bolus within the oral cavity along with the buccinator, the muscular lining of the cheeks.
- The buccinator connects with the orbicularis oris anteriorly & superior pharyngeal constrictor posteriorly.
41
What nerve innervates all facial muscles?
Facial Cranial Nerve VII innervates all facial muscles.
42
Patients with Bell’s Palsy that affects facial cranial nerve VII may present with what type of difficulty?
Patients with Bell’s Palsy affecting facial cranial nerve VII may present with difficulty ingesting or retaining a bolus in the oral cavity.
43
What muscles are responsible for mastication?
- Masseter
- Temporalis
- Medial Pterygoid
- Lateral Pterygoid
- Anterior Digastric
- Mylohyoid
44
What muscles are responsible for jaw closure?
The masseter & medial pterygoid, which form the “v-sling” muscles.
45
What is the bottom of the @v-sling” made up of?
The bottom of the “v-sling” is made up of the distal attachment of each muscle meeting at the superficial & deep surface of the mandibular angle.
46
Where is the proximal attachment site of the masseter located?
The proximal attachment site of the masseter is located at the zygomatic arch
47
What is the proximal attachment of the medial pterygoid?
The medial surface of the lateral pterygoid plate is the proximal attachment of the medial pterygoid?
48
What muscles complete the “v-shaped sling”?
- The proximal attachment site of the masseter is located at the zygomatic arch.
- The medial surface of the lateral pterygoid plate is the proximal attachment of the medial pterygoid.
49
What muscle is a powerful jaw-closer has a broad attachments on the flat bones of the skull in the temporal fossa?
Temporalis
50
What converge as they descend deep to the zygomatic arch & form a tendon inserting on the coronoid process of the mandible?
Muscles fibers converge as they descend deep to the zygomatic arch & form a tendon inserting on the coronoid process of the mandible.
51
What nerves and cranial nerve innervates the muscles of mastication (e.g., masseter, temporalis, medial pterygoid, lateral pterygoid, anterior digastric, mylohyoid)?
All are innervated by the mandibular nerve, & 3rd division of the trigeminal cranial nerve V 3.
52
What muscles are jaw openers?
- Lateral Pterygoid arises from the lateral surface of the lateral pterygoid plate & inserts both posterolaterally on the anterior surface of the neck of the mandible & on the articulation disk of the temporomandibular joint.
- Suprahyoid Muscles, including the digastric, mylohyoid, geniohyoid, & stylohyoid, forma muscular sling attached to the inner surface of the body of the mandible anteriorly, the cranial base posteriorly, & the hyoid in the middle.
- Together, these muscles have the mechanical advantage to open the jaw.
53
What nerve innervates the mylohyoid & anterior digastric?
The mandibular branch of the Trigeminal Cranial Nerve V.
54
What nerve innervate the posterior digastric and styloid?
Facial Nerve VII
55
What nerve innervate the geniohyoid?
C1 Spinal Nerve
56
What muscle is the primary jaw opener?
Lateral Pterygoid is the primary jaw opener under normal conditions.
57
What other important functions of the suprahyoid muscles?
Supporting the actions of the tongue in the oral cavity.
58
As a group, the mylohyoid, geniohyoid, and anterior digastric muscles are referred to as?
The floor of the mouth or submental muscles is the reference to the mental protuberance of the mandible.
59
What is a muscular hydrostat with intrinsic muscles oriented in longitudinal, vertical, & transverse planes, allowing for multiple degrees of freedom?
Tongue
60
What courses through the long axis of the tongue?
The superior & inferior longitudinal muscles.
61
What muscles interwoven throughout the body of the tongue?
The transversus & verticalis muscles are interwoven throughout the body of the tongue.
62
What type of muscles largely control the shape of the tongue?
Intrinsic muscles largely control the shape of tongue.
63
What type of muscles control the position of the tongue in the oral cavity?
Extrinsic muscles directly control the position of the tongue in the oral cavity, and indirectly by the suprahyoid muscles & muscles of mastication.
64
What muscles are responsible for the repositioning the tongue in the oral cavity?
- Genioglossus
- Palatoglossus
- Styloglossus
- Hyoglossus
65
What are the extrinsic muscles of the tongue that are named for their respective attachments?
- Anteriorly to the genial tubercle of the mandible
- Superiorly to the palate
- Posteriorly to the styloid process
- Inferiorly to the hyoid
66
What are often classified functionally as protruders or retruders?
Tongue muscles are often classified functionally as protruders or retruders.
67
What muscles are primarily responsible on protruding the tongue?
- Genioglossus
- Transversus
- Verticalis
68
What muscles are primarily responsible in retruding the tongue?
- Hyoglossus
- Styloglossus
- Longitudinal muscles
69
What muscles are responsible to support the posture of the tongue in the oral cavity?
- Suprahyoid muscles
- Muscles of Mastication
• Masseter
• Temporalis
• Medial Pterygoid
• Lateral Pterygoid
• Anterior Digastric
• Mylohyoid
70
What muscles are involved in mastication to support the tongue during bolus formation?
The floor of mouth muscles are especially involved in mastication to support the tongue during bolus formation.
71
What muscles is responsible for stiffen to support the tongue pressing against the palate?
The submental muscles stiffen to support the tongue pressing against the palate.
72
What influences the posture of the tongue?
The posture of the tongue is influenced by the posture of the jaw.
73
What cranial nerves coordinate the tongue movements, facial muscles, muscles of mastication, & floor of the mouth muscles involve central pattern generators in the brainstem?
The coordinating motor nuclei of Trigeminal Cranial Nerve V, Facial Cranial Nerve VII, & Hyoglossus Cranial Nerve XII.
74
What type of stroke would be devastating for swallowing?
The location of these central patterns generators explain why a brainstem stroke, also called a bulbar stroke, is so devastating for swallowing.
75
What muscles are the underlying oral transport?
- Bolus transport through the oral cavity involves the tongue accommodating the bolus & moving it toward the pharynx & concludes with forceful tongue base retraction.
- The facial muscles contain the bolus by keeping the mouth closed or fixed around a cup or straw.
- The muscles of mastication keep the jaw fixed, & submental muscles support the effort of the tongue.
- Anterior fibers of the genioglossus from anterior to posterior with the intrinsic muscles of the tongue rolls the bolus through the oral cavity.
- The tongue base, pulled like a piston by the hyglossus & styloglossus, drives the bolus into the hypopharynx.
76
What cranial nerve innervate the muscles underlying oral transport?
Hypoglossal Cranial Nerve XII
77
What are the key contractile elements are a series of the muscular slings that insert what in the pharyngeal phase of swallowing?
The key contractile elements are a series of muscular slings that insert on bones, cartilages, other muscles, or fascia.
78
What does these sling muscles function as, and what are bound together by?
- These muscular slings function to seal off openings & help transform the morphology of the pharynx.
- These sling muscles function cooperatively & are often bound together by deep fascia, so that muscles function less like ropes pulling on a structure & more like two ends of a hammock that surround & displace a structure.
79
What cranial nerve innervate the tensor veil palatini?
The mandibular branch of the Trigeminal Cranial Nerve V 3.
80
What is the origin, and attachment of the Tensor Veli Palatini muscle?
The tensor veli palatini originates in the fossa between the pterygoid plates & uses the pterygoid hamulus as a pulley to stiffen the palatine aponeuroses embedded in the soft palate.
81
Where does the levator veli palatini attach and pass through?
- The levator veli palatini attaches to the cranial base near the carotid canal & auditory tube on the temporal bone.
- It passes over the edge of the superior pharyngeal constrictor & into the soft palate to form a sling of muscles within the substance of the soft palate.
- These muscle fibers attach to the palatine aponeuroses & associate with the musculus uvulae, the only intrinsic muscle of the soft palate, which attaches to the posterior nasal spine.
82
What cranial nerve innervate the levator veli palatini?
The pharyngeal branch of the Vagus Cranial Nerve X.
83
What is the primarily function of the levator veli palatini in swallowing?
- The primarily function of the levator veli palatini in swallowing is to seal the veli pharyngeal port.
- Secondarily, this muscle anchors & leverages the proximal attachments of the palatopharyngeus (innervated by the pharyngeal branch of the Vagus CN X), & therefore indirectly contributes to important functions of swallowing other than the closure of the soft palate.
84
What type of surgical procedures that are designed to address that may inadvertently cause swallowing impairment if these muscles or nerves are compromised?
Surgical procedures that are designed to address obstructive sleep apnea may inadvertently cause swallowing impairment if these muscles or nerves are compromised.
85
What muscle sling the tongue in the oral cavity?
The tongue itself is slung in the oral cavity by the genioglossus anteriorly & the styloglossus posteriorly.
86
What muscles attaches to the greater horn of the hyoid & rises through the lateral walls of the tongue?
The hyoglossus attaches to the greater horn of the hyoid & rises through the lateral walls of the tongue.
87
What muscles attaches to the styloid process & inserts into the lateral tongue, embracing the fibers of the hyoglossus?
The styloglossus attaches to the styloid process & inserts into the lateral tongue, embracing the fibers to the hyoglossus.
88
What two muscles contract & together pull the tongue base posteriorly in tongue base retraction?
- Styloglossus
| - Hyoglossus
89
What muscle is positioned to suspend the tongue & this little muscle approximates the palate to the tongue base, helping to seal the oropharyngeal isthmus during the pharyngeal conversion?
Palatoglossus muscles
90
What cranial nerve innervate the Palatoglossus muscles?
Vagus Cranial Nerve X
91
What cranial nerve innervates all other tongue muscles?
Hypoglossal Cranial Nerve XII
