Chapter 8 Flashcards
Iowa Oral Pressure Instrument (IOPI)
Flexible ball that measures force - tongue or lips
Electromyography
Measures muscle function during swallowing
Pharyngeal manometry
Pressure measure
Modified barium swallow study (MBSS
Videoradiographically record individual ingesting barium of various textures - anterior and lateral views
–Definitive test of oropharyngeal dysphagia
Fiberendoscopic evaluation of swallow (FEES)
Detect aspiration and pharyngeal residue, can visualize structures - see tumors
–Do not have radiology exposure or consumption of barium
Ultrasound
–Observe movement during swallowing but bone impedes visualization
Mastication
food preparation process, including chewing food, mixing it with saliva, grinding food with the teeth
–The end-product of mastication is a bolus or a quantity of material to be swallowed
Deglutition
swallowing process
4 phases of deglutition
Oral preparation
–Oral transit
–Pharyngeal
–Esophageal
Structures in deglutition
Deglutitive anatomy includes the structures of the oral cavity, the pharynx and larynx, as well as the esophagus
Important oral cavity structures include:
Muscles and others
Labiae and labial mm –Buccal cavity, as well as buccal mm –Dentition –Mandible and mandibular mm –Palate and velar mm –Intrinsic and extrinsic lingual mm –Salivary glands
Labial and buccal muscles assistance
Labial and buccal muscles assist in oral containment of the bolus and include the upper lip elevator mm and lower lip depressor mm
–Buccal contraction assists in keeping the food out of the lateral sulcus
Labial and buccal muscles involved In deglutition
MM that are primarily involved: obicularis oris, mentalis, buccinator and risorius
Dental contributions to mastication
Dental contributions to mastication include cutting, grinding and tearing
–Incisors – cut
–Cuspids – tear (meat)
–***Molars – grind
Mandibular mm support the mastication process
Masseter, temporalis, medial and lateral pterygoid
Additional anatomy involved in mastication include
The soft palate and posterior tongue create a seal to avoid premature spillage in adult swallowing
–Lingual muscles move food off/onto the dental grinding surfaces
–Salivary glands (3) are active and adding saliva aids in creating a cohesive bolus
Mastication involves
Mastication involves labial, lingual, dental, buccal, salivary, and mandibular components of the oral cavity
–Dentition and mandibular mm provide structures and motion for the act of chewing
•Mandibular mm work in a semi-rotary fashion to support dental grinding
Food during mastication
–Mastication requires that food does not spill anteriorly (i.e., a good labial seal) or posteriorly (i.e., posterior tongue and velum) or laterally (i.e., buccal mm)
–Lingual action assists in moving the food off/onto the dental grinding surfaces
–Salivary glands help in creation of a cohesive bolus
Anatomy involved in moving the bolus
Anatomy involved in moving the bolus through the oral cavity towards the pharyngeal cavity include –Lingual mm –Velar mm –Labial mm –Buccal mm
Lingual mm involvement
Lingual mm involvement relates to raising the bolus with the tongue tip and then moving the bolus in a posterior direction by squeezing the bolus along the palate
–Sequential activation of anterior and then posterior lingual mm
–The soft palate raises to allow continued movement through the oral cavity
Bolus propulsion occurs secondary to
–Mandibular elevator mm
–Lingual mm
•Mylohyoid elevates the tongue
•Sup. Longitudinal elevates the tongue tip
•Vertical cups/grooves the tongue
•Genioglossus moves the tongue body
•Styloglossus and palatoglossus elevate the posterior tongue
Bolus cohesion is maintained secondary to
Labial mm (mainly the obicularis oris)
–Buccal mm (risorius and buccinator mm)
–Saliva that has been added during preparation (parotid, sublingual, and submandibular glands)
3 different types of salivary glands
parotid, sublingual, and submandibular glands
What happens during oral transit
Following oral preparation, the bolus is gathered in the anterior aspect of the mouth and moved towards the posterior via a stripping motion of the tongue against the hard palate –Additional events include: •Persistent labial seal •Velar elevation •Persistent buccal mm contraction
swallow reflex
The swallow reflex is triggered when the bolus reaches about the level of the anterior faucial pillars
•With triggering of the swallowing reflex, various pharyngeal events begin to occur
Important pharyngeal structures include
Epiglottis –Vallecular and pyriform spaces/sinuses –Intrinsic and extrinsic laryngeal mm –Velar mm –Pharyngeal mm
Velar Deglutitive Anatomy
Velar elevation closes off the nasopharynx to avoid nasal regurgitation
–Levator veli palatini and uvula
Intrinsic laryngeal muscles
Intrinsic laryngeal muscles that help to close off the airway entrance at
•The vocal folds (laryngeal adductors)
•The ventricular folds
Extrinsic laryngeal muscles (elevators)
help to raise and move the larynx forward
•This action helps to invert the epiglottis and close off the laryngeal aditus via its connection to the hyoid (hyoepiglottic ligament)
Pharyngeal constrictor muscles and other pharyngeal mm
Pharyngeal constrictor muscles and other pharyngeal mm whose contraction
•Help close the velopharynx (SPC)
•Raise and reduce the diameter of the pharynx
•Open the upper esophageal sphincter
–Base of tongue mm that work in concert with the pharyngeal constrictors
The opening of the upper esophageal sphincter
The opening of the upper esophageal sphincter is related to several factors
–Traction from laryngeal movement
–Contraction/relaxation of the cricopharyngeus
–Effects of gravity on the bolus
Pharyngeal Phase I
Velo-pharyngeal closure occurs
•Hyo-laryngeal excursion along with bolus pressure assist in inversion of the epiglottis
•Laryngeal closure and hyo-laryngeal elevation and anterior movement occur as well as apnea to protect the airway
Pharyngeal Phase II
As the bolus enters the pharynx, sequential pharnygeal mm contraction along with base of tongue mm contraction help to move the bolus in an inferior direction along with gravity
•Hyo-laryngeal traction and crico-pharyngeal contraction help to open the upper esophageal sphincter
•The bolus passes into the esophagus
•The upper esophageal sphincter closes
2 sphincters
Upper esophageal sphincter (UES)
–Lower esophageal sphincter (LES)
Esophageal Anatomy
The esophagus is the anatomical tube connecting the pharynx and stomach
•It is bounded by 2 sphincters
–Upper esophageal sphincter (UES)
–Lower esophageal sphincter (LES)
•The esophagus contains smooth and striated muscle
Esophageal phase
Successive contraction of esophageal mm propel the food towards the LES
•LES contraction occurs, relaxing the muscle, and allows for passage of the bolus into the stomach
Clinical Application
SLPs are directly involved in examination of swallow & making diagnoses of dysphagia
•Examinations may be instrumental or non-instrumental, with among the most informative instrumental evaluation being MBS or VFSS or cookie swallow
–MBS has long been considered the gold standard and involves fluoroscopic assessment of swallow structures/function
•Another instrumental evaluation is the naso-endoscopic evaluation of the swallow (or flexible endoscopic swallow evaluation)
