Exam 1 Flashcards
Muscles responsible for Mandible Elevation
Masseter, temporalis, medial pterygoid
Masseter (mandible elevation)
Origin: zygomatic arch (cheek)
Insertion: mandible at angle
Innervation: V (mandibular branch of trigeminal)
Temporalis (mandible elevation)
Origin: temporal bone (lateral surface)
Insertion: coronoid process of mandible
Innervation: V (mandibular branch of trigeminal)
Medial Pterygoid
Origin: sphenoid bone
Insertion: inner surface of mandible
Innervation: V (mandibular branch of trigeminal)
Muscles responsible for Mandible Protrusion
lateral pterygoid
Lateral pterygoid (mandible protrusion)
Origin: sphenoid bone
Insertion: mandible at condyle
Innervation: V (mandibular branch of trigeminal)
Muscles responsible for Mandible Depression
Geniohyoid, mylohyoid, anterior belly digastric
Geniohyoid (mandible depression)
Origin: hyoid
Insertion: mandible, inner anterior surface
Innervation: C1 root
Mylohyoid (mandible depression)
Origin: hyoid
Insertion: mandible, inner surface
Innervation: V (mandibular branch of trigeminal)
Anterior belly digastric (mandible depression)
Origin: hyoid
Insertion: mandible, inner anterior surface
Innervation: V (mandibular branch of trigeminal)
Muscles responsible for HLE with anterior movement
geniohyoid, mylohyoid, anterior belly digastric
Geniohyoid (HLE with anterior movement)
Origin: mandible, inner anterior surface
Insertion: hyoid
Innervation: C1 root
Mylohyoid (HLE with anterior movement)
Origin: inner surface of mandible
Insertion: hyoid
Innervation: V (mandibular branch of trigeminal)
Anterior belly digastric (HLE with anterior movement)
Origin: mandible, inner anterior surface
Insertion: hyoid
Innervation: V (mandibular branch of trigeminal)
Muscles responsible for HLE with posterior movement
stylohyoid, posterior belly digastric
Stylohyoid (HLE with posterior movement)
Origin: styloid process of temporal bone
Insertion: hyoid
Innervation: VII facial
Posterior belly digastric (HLE with posterior movement)
Origin: mastoid process of temporal bone
Insertion: hyoid
Innervation: VII
Muscle responsible for tongue protrusion
Genioglossus
Genioglossus (tongue protrusion)
Origin: anterior mandible near geniohyoid
Insertion: body of tongue
Innervation: XII hypoglossal
Muscle responsible for vertical HLE
Hyoglossus
Hyoglossus (vertical HLE)
Origin: tongue body
Insertion: hyoid greater horns
Innervation: XII facial
Muscle responsible for tongue base elevation
Palatoglossus
Palatoglossus (tongue base elevation)
Origin: soft palate
Insertion: tongue base laterally through anterior faucial pillars
Innervation: X
Muscle responsible for tongue base elevation and retraction
styloglossus
Styloglossus (tongue base elevation/retraction)
Origin: styloid process of temporal bone
Insertion: tongue base to tip
Innervation: XII (hypoglossal)
Muscle responsible for tongue depression
hyoglossus
Hyoglossus (tongue depression)
Origin: hyoid
Insertion: tongue
Innervation: XII (hypoglossal)
Muscles responsible for tongue shaping
Intrinsic muscles of the tongue: vertical, transverse, and longitudinal
Muscle responsible for velum depression
palatoglossus
Palatoglossus (velum depression)
Origin: tongue base laterally through anterior faucial pillars
Insertion: soft palate
Innervation: X (vagus)
Muscle responsible for velum elevation
levator veli palatini
Levator veli palatini (velum elevation)
Origin: skull base
Insertion: soft palate
Innervation: X (vagus)
Muscle responsible for velum tensing
tensor veli palatini
Tensor veli palatini (velum tensing)
Origin: sphenoid
Insertion: bilaterally to midline velum
Innervation: V trigeminal
Muscles responsible for pharynx elevation
palatopharyngeus, stylopharyngeus, salpingopharyngeus
Palatopharyngeus (pharynx elevation)
Origin: hard palate
Insertion: lateral walls of pharynx
Innervation: X (vagus)
Stylopharyngeus (pharynx elevation)
Origin: styloid process of temporal bone
Insertion: pharynx
Innervation: IX (glossopharyngeal)
Salpingopharyngeus
Origin: near toris tubarius
Insertion: pharynx
Innervation: X (vagus)
Muscles responsible for pharyngeal constriction
superior, middle, and inferior constrictors (O: cricoid, arytenoidsm thyroid cartilage I: arytenoids In: X (vagus) via RLN
Muscles responsible for vocal fold adduction
lateral cricoarytenoids, vocalis, and thyro and interarytenoids
Muscles responsible for vocal fold abduction
posterior crycoarytenoid
Muscle responsible for UES closure
cricopharyngeus
Cricopharyngeus
Origin: cricoid
Insertion: C-shaped pharynx
Innervation: X via RLN
Muscles responsible for larynx depression and stabilization
sternohyoid, sternothyoid, thyrohyoid
Sternohyoid (larynx depression and stabilization)
Origin: sternum
Insertion: hyoid
Innervation: C2-C3
Sternothyroid (larynx depression and stabilization)
Origin: Sternum
Insertion: thyroid cartilage
Innervation: C2-C3
Thyrohyoid (larynx depression and stabilization)
Origin: thyroid cartilage of larynx
Instertion: hyoid
Innervation: C2-C3
Sternocleidomastoid (head turn)
Origin: Sternum, head of clavicle
Insertion: Mastoid process of temporal bone
Innervation: XI (accessory)
Consequences of inhaled bolus
Aspiration and pneumonia
The ball of food/liquid being swallowed
Bolus
Occurring while eating or drinking
Prandial
Nutrition delivered directly to the gut
Enteral
Nutrition delivered directly to the central large vein
Parental
Swallowing, ingestion
Deglutition
Foreign material enters larynx, remains above glottic plane
Penetration
Foreign material enters trachea
Aspiration
Oral Stages of Swallow
- Oral preparatory
- Oral transit
- Stage transition
Pharyngeal stages of swallow
- pharyngeal stage
2. esophageal stage
Oral preparatory phase
food/liquid taken into the mouth
Difference between food and liquid in the mouth
Liquids: linguavelar valve closed, bolus positioned for transit
Foods: – bolus positioned for mastication. Mastication
including rotary mandible movement, crushing of bolus.
Tongue moves bolus for mastication.
Oral transit stage
prepared bolus is propelled by tongue to palate progressive anterior to posterior contact.
a. Liquids typically all at once
b. Solids aggregate in pharynx until pharyngeal
response begins
Pharyngeal phase onset
Pharyngeal response begins
a. Linguavelar closure (liquid) ends, velopharyngeal
closure begins
b. Bolus head enters pharynx (passes faucial arch)
1. Young: a occurs before b
2. Aging: b occurs before a
a. Prolonged stage transition
c. Disordered: a begins abnormally later than it
should based on age
Pharyngeal transit stage
Velopharyngeal closure completes Pharyngeal tube constriction begins UES resting tone inhibition Increases UES compliance Vocal folds adduct Hyolaryngeal excursion (anterior, superior) Traction forces on larynx UES Epiglottis inverts, vocal folds adduct Airway closes, breathing stops Bolus enters UES, clears UES Hyolaryngeal excursion ends, UES closes Structures return to rest
Esophageal transit stage
UES remains tightly closed
Superior to inferior “peristalsis” (constriction)
of esophageal muscles
Circular muscles constrict top to bottom
Longitudinal muscles shorten
Net result is propulsion
LES (tightly closed at rest) “relaxes” when
pressure of bolus (intrabolus pressure) rises
LES opens, bolus enters stomach
Bolus clears LES
LES closes
Development of embryo weeks 4-8
Now known as “pharyngeal arches”
Neural and organ development
Cranial nerves form
Development of embryo weeks 9-12
Sucking is observed (non-nutritive)
Fetus begins swallowing amniotic fluid
Taste buds form
Development of embryo weeks 13-on
Limbs start to move, skin forming
Alveolar surfactant (20-25 wk.)
Respiratory movements are spontaneous
Fetus can survive at about 25+ weeks
Anatomical changes from infant-adult
Elongation/enlargement of pharynx,
larynx, oral cavity
Lowering of laryngeal, BOT position
Loss of buccal pads-more muscle activity needed
Muscles that pull hyoid toward the mandible
Mylohyoid (V)
Anterior digastric (V)
Geniohyoid (C1)
Pulls hyoid toward skull base
Stylohyoid (VII) Posterior digastric (VII)
Pulls hyoid toward tongue
Hyoglossus (XII)
Pulls larynx toward hyoid
Thyrohyoid (C2)
HLE anterior superior movement….
Pulls airway out of bolus path
Contributes to epiglottic inversion
Pulls open UES
Pulls tongue backwards and upward
Palatoglossus (X) and styloglossus (XII)
Pulls tongue backwards and downwards
Hyoglossus (XII)
Tongue depression
Hyoglossus (XII)
Tongue retraction and elevation
Styloglossus (XII)
Tongue to soft palate contact
Palatoglossus (X)
3 types of salivary glands
- Parotid
- Buccal
- Submandibular, sublingual
Parotid salivary gland
Innervated by IX, located in the lateral mandible
Buccal salivary gland
Innervated by VII, located in the cheek
Sublingual and submandibular gland
Innervated by VII, located in the floor of the mouth
Space between tongue base and epiglottis
Valleculae (2)
Space lateral to the larynx
Pyriform sinuses
General duties of Masseter/pterygoids
mandibular elevation-bolus containment, lingual
stabilization
General duties of Soft palate elevators
velopharyngeal closure
General duties of Suprahyoids
elevation and (net) anterior displacement of HLC (HLE), UES distension Mylo-, geniohyoid, digastrics, Mandibular depression
General duties of Infrahyoid
laryngeal stabilization
General duties of pharyngeal constrictors
pharyngeal
peristalsis (wavelike top to bottom contraction-bolus propulsion)
General duties of pharyngeal elevators
Bolus propulsion
General duty of Cricopharyngeal segment of inferior
constrictor
UES closure
Mandible elevators CN V
Masseter
Both pterygoids
Temporalis
Mandible protruders CN V
lateral pterygoid
Mandible lateralizers CN V
Pterygoids, temporalis
Mandible depressors + innervations
Mylohyoid CN V
Anterior Belly of Digastric (ABD) CN V
Geniohyoid (C1 roots)
Hyolaryngeal Elevators (anterior-superior)
Mylohyoid CN V
Anterior Belly of Digastric (ABD) CN V
Geniohyoid (C1 roots)
Hyolaryngeal elevators (posterior-superior)
Stylohyoid, posterior belly of digastric (VII)
Hyolaryngeal elevators (superior)
hyoglossus (XII)
Tongue posterior-superior movement
Palatoglossus (X)
Styloglossus (XII)
Tongue depression
Hyoglossus (XII)
Tongue shaping
All lingual intrinsic muscles (XII)
Shortening: superior and inferior longitudinals
Narrowing: transversus
Flattening: verticalis
Tongue protrusion
Genioglossus (XII)
Soft palate contact with pharyngeal
walls
Levator veli palatini (X)
Assist: Tensor veli palatini (V)
Soft palate contact with tongue base
Palatoglossus (X)
Pharyngeal constriction, elevation
Pharyngeal constrictors (X through pharyngeal plexus) Pharyngeal elevators: Stylopharyngeus (IX) Salpingopharyngeus, palatopharyngeus (X)
UES tone maintenance
Cricopharyngeal segment of inferior constrictor
X via recurrent laryngeal nerve - RLN
Intrinsic laryngeal musculature
Adductors and abductors: (X via RLN)
Tensors and “tighteners”: (X via RLN and
SLN (CT))
Esophageal peristalsis
Circular, longitudinal esophageal layers
X and myenteric plexus
Tactile sensation - anterior to soft palate
V - Inside mouth and outside mouth
VII – outer ear
Tactile sensation - Palate, pharynx, tongue base
Mixed fibers of pharyngeal plexus (IX, X, XI)
Taste sensation
Anterior 2/3 of tongue: VII
Posterior 1/3 of tongue: IX
Valves of swallowing
velopharyngeal port
tonguebasetopharyngealwall
laryngeal(3)
cricopharyngealsphincter
What law of pressure is used in the swallow mechanism?
Boyles law
Steps of the oral preparatory stage
Mastication(rotary) Salivation BolusFormation/Shaping OralSensation/Enjoyment OralContainment
Steps of oral transit stage
BolusContainmentandCompression BolusReleaseandPropulsion Development/maintenanceofIntrabolusPressure Directionalpropulsion Releaseoflinguavelarseal
Steps of pharyngeal phase
Positive(propulsive)forces
Hyolaryngealexcursion
Steps of esophageal phase
Peristaltictop‐to‐bottomcontraction
LES closedatrest(before,afterbolus)
PressureaboveLESrises
Factors that vary swallows in normal people
BolusVolumeaffectsbiomechanics VariabilityinboluspositionatonsetofHLE TippersandDippers Aging StrawDrinking BreathingandSwallowingCoordination SwallowingSolids
CNS
brain and spinal cord
PNS
cranial and spinal nuclei
Major structures of CNS
Cerebral hemispheres (Frontal, parietal, occipital, temporal lobes, cerebellum) Brainstem (Midbrain, pons, medulla oblongata) Spinal cord
Grey matter
clusters of nuclei, unmyelinated axons
White matter
Tracts of axons projecting between clusters of
nuclei, Myelinated (white)
Cranial/Spinal motor nucleus
origin of outgoing cranial/spinal motor nerve
Cranial/Spinal Sensory nucleus
end of incoming cranial/spinal
sensory nerve
PNS
Each cranial or spinal motor nerve emanates
from a cranial or spinal motor nucleus
Each cranial or spinal sensory nerve
terminates in a cranial or spinal sensory
nucleus.
Upper Motor Neurons (UMN)
Axons projecting between brain and cranial/spinal
nuclei
Emanate from “giant” pyramidal motor cells in cortex
Terminate in cranial/spinal motor nucleus
Brain to spinal cord tracts
corticospinal tracts
Brain to brainstem tracts
corticobulbar tracts