Dysfunction in swallowing anatomy Flashcards
Impaired palatopharyngeal muscle could cause?
-Regurgitation
-nasal voice (hypernasality)
-Aspiration
Outcomes of reduced saliva?
-Poor oral hygiene
-Bacteria in mouth
-Tooth decay
-Lack of saliva breaking down food
-Lack of oral moisture
-Lack of food lubrication
Dysfunction leading to aspiration AFTER swallow
-Lack of sensation (SLN and RLN damage)
-Residue in pharynx or larynx
-Upper esophageal sphincter remaining open
Pharyngeal residue sites?
-Pyriform sinuses
-Base of tongue
-Posterior pharyngeal wall (along nasopharynx, oropharynx, or hypopharynx)
-Valeculla
Larynx residue sites?
-True vocal folds
-False vocal folds
-Supraglottic or subglottic space
-epiglottis
Dysfunction in oral cavity that could cause aspiration BEFORE swallowing?
-impaired anterior facial pillars (lack of posterior seal of oral cavity)
-Impaired sensation (lack of awareness of bolus location)
Residue sites in the oral cavity
-Lips
-tongue
-Floor of mouth
-Facial pillars
-Anterior and lateral sulci
Define aspiration
Entry of food or liquid into the airway BELOW true vocal folds
Define penetration
Entry of food or liquid into the larynx at some level down, but ABOVE true vocal folds
Define residue
Food left behind in the mouth or pharynx after the swallow
Define regurgitation (backflow )
Food from the esophagus flowing back up into the pharynx and/or from the pharynx into the nasal cavity
Continued presence of aspiration can lead to?
Aspiration pneumonia
define silent aspiration
Pt sensitivity is reduced, so when they aspirate (food goes below true vocal folds) they don’t cough or demonstrate other visible or audible signs
Possible causes of difficulty swallowing liquids
-Suggestive of a neurological disorder
-Age related swallowing difficulties (presbyphagia)
Possible causes of difficulty swallowing solid foods
-structural abnormality
-sign of neuromuscular disease affecting the pharyngeal muscles
Possible causes of regurgitation
-a pharyngeal pouch (zenker’s disease)
Possible cause of progressive dysphagia
-neuromuscular disease
-tumor
Possible causes of of hoarseness
-laryngeal tumor
-neck masses caused by enlarged thyroid, compressing the esophagus
Possible cause of dysphagia related weight loss
-pain or discomfort during eating
-if progression is rapid, may indicate something serious, requiring urgent investigation
Oropharyngeal dysphagia is prevalent within which populations?
- nursing home residents
- hospital inpatients
- dementia
- normal elderly population
- head and neck oncology
Why is dysphagia prevalent within the normal elderly population?
-weight loss
-decreased thrist sense
-decreased appetitie
-sarcopenia (muscle deterioration/loss)
Individuals within hospital inpatient settings have increased risk of developing dysphagia due to?
-intubations
-enteral tubes
-tracheotomy
-sedation
-mental status
-debilitated status
Possible causes of dysphagia?
- foreign bodies
- cricopharyngeal achalasia
- zenker’s diverticulum
- lateral pharyngeal pouches and diverticula
- cervical spine disease
- esophageal webs
- esophageal ring (schatzki’s ring)
- tracheostomy
- strictures
- achalasia
- diffuse esophgeal spasm
- GERD
- Larynx or pharynx cancer
- Esophagus cancer
- Amyotrophic lateral sclerosis (ALS)
- parkinson’s disease
- muscular dystrophy
- myasthenia gravis
- autoimmune disorder
- aging
- globus hystericus
- stroke
- laryngeal nerve injury
The presence of residue patterns indicates there could be…
- weakness in tongue, pharyngeal muscles, or paralysis
- Fibrosis s/p chemorad
- Upper esophageal sphincter dysfunction (spasm or stricture)
- Sensory deficit
- Neurological disorder
