Chewing and swallowing Flashcards
Chewing (Mastication)
Alignment of the maxilla, mandible and teeth is important for proper biting forces exertion
Grinding, mashing, crushing, kneading food to form a bolus
Swallowing (Deglutation)
- Closing off the nasopharynx with velum
* Muscles of the oropharynx and laryngopharynx propel bolus downward through the pharyngeal tube into the esophagus
Deglutation
3 phases
Deglutation has 3 phases
Oral transport phase
Pharyngeal transport phase
Esophageal transport phase
Deglutation
Oral Transport phase
Oral transport phase
- Tongue propels the bolus backward
- Velum elevates
- Pharyngeal walls begin to constrict
- lasts less than 0.5 seconds!!!
- Problems may occur if tongue is weak or velum cannot be elevated to close of the velopharynx
Deglutation
Pharyngeal Transport phase
Pharyngeal transport phase
* happens automatically
*Triggered when the bolus passes the anterior faucial pillars
*The hyoid bone and larynx move upward & forward (contraction of the extrinsic tongue muscles move the hyoid bone upward, hyoid bone is connected to larynx and moves the larynx upward as well)
Hyolaryngeal complex
Deglutation
Transport phase 2
- Airways are protected by vocal fold closure and downward movement of the epiglottis
- Opening of the esophageal sphincter to allow passage of the bolus into the esophagus
- Relaxation of the cricopharyngeus and stretching of esophageal opening by upward movement of hyolaryngeal complex
Deglutation
Esophageal transport phase
Esophageal transport phase
Begins when the bolus enters the upper esophageal sphincter
Ends when the bolus passes into the stomach through the lower esophageal sphincter
Phase lasts anywhere from 8-20 seconds
Bolus is being propelled by peristaltic actions of the esophageal walls
Peristaltic contraction raises the pressure behind the bolus
Relaxation lowers the pressure in front of the bolus
Why swallowing function screening?
- To determine if instrumental assessment is necessary
* Initiate safety recommendations for patient (take medications?)
Swallowing function screening:
Bedside evaluation
*Interview with patient and/or family member
*Oral Motor Examination
Oro-facial structures and functions
*At rest, range of movements, strength, reflexes
*Vocal quality:aphonia (no voice), breathy voice (lots of air) - suggests risk of aspiration
*Actual swallowing assessment (Ice chips, water, apple sauce, pudding, cracker, water in larger amounts
If possible: observe patient during entire meal
Swallowing Disorders (Dysphagia/difficulty swallowing) causes
- Primarily organic cause
- Neurogenic (nerve origin) causes
ex: Stroke, degenerative diseases (Parkinson’s, ALS, Multiple Sclerosis) - Tumor growth in oral or pharyngeal cavity
- Deformation (oro-facial restoration surgery post trauma)
Swallowing Disorders (Dysphagia/difficulty swallowing) causes
Occasionally psychogenic causes
Lump in throat, cannot swallow
Signs of Dysphagia: oral stage
Drooling/anterior bolus loss
Prolonged chewing
Tongue pumping to propel food towards pharynx
Residuals in oral cavity (buccal cavity, tongue blade, palate) after swallowing
Premature spillage into pharynx
What are some examples of oral stage dysphagia?
Tumor growth in oral cavity (tongue, lips, tonsils, floor of the mouth) Parkinson’s Disease, Dementia, Stroke (unilateral paralysis of the oral & facial muscles)
TBI
What treatments are available for oral stage dysphagia?
Treatments for oral stage dysphagia
- Alternative swallowing techniques (Chin tuck)
- Modify food so it becomes manageable to swallow (Puree foods)
Signs of Dysphagia:pharyngeal stage
Wet vocal quality (gurgly voice)
Frequent coughing during meals
Wet cough after swallowing saliva
