HNS 3 Flashcards
The 5 phases of swallowing
-oral (prepartory + transit) phase
-pharyngeal (I + II) phase
-oesophageal phase
what sort of function is needed for the oral preparatoryphase
lip, jaw, tongue and palate sensory and motor function + dentition
oral preparatory phase
voluntary task where the air way is open and food/liquid chewed and formed into a bolus
what nerves take part in the oral preparatory phase
cranial nerves
-V, VII, IX, X, XII
-trigeminal nerve, facial nerve, glossopharyngeal, vagus and hypoglossal
oral transit phase
voluntary control where airway is open and bolus propelled to back of mouth and the soft palate seals entrance to nasal cavity
what are the functions needed for oral transit phase
lip, jaw tongue and palate sensory and motor function needed
what nerves supply the oral transit phase?
V, VII, IX, X, XII
pharyngeal phase I
-reflex control when the airway is closed and bolus reaches faucial arch (back of mouth) while the palate stays elevated
-tongue retracts, pushing bolus to pharynx
what nerves supply the pharyngeal phase I?
pharynx: IX, X
tongue: XII
what are the functions needed for phayngeal phase I
tongue, palate and laryngeal sensory and motor function needed
pharyngeal phase II
Reflex control where airway is closed by epiglottis, vocal cords and arytenoid action
+ bolus propelled through pharaynx
what nerves supply the pharyngeal phase II?
IX, X, XII
what are the functions needed for phayngeal phase II
tongue, palate and laryngeal sensory and motor function needed
what are the functions needed for phayngeal phase II
tongue, palate and laryngeal sensory and motor needed
oesophageal phase
reflex control where oesophagus opensm airways closed tf breath held
-bolus propelled through oesophagus
-respiration then resumes with an exhalation to clear any food particles from airway entrance
what nerves supply the oesophageal phase?
IX, X
what type of imaging can we use to examine swallowing?
videofluoroscopy
what is an ataxic swallow
-uncoordinated tongue retraction to propel food causing delayed airway closure
what can cause ataxic swallow?
cerebellar haematoma
fix for ataxic swallow
flexed neck during swallow prevents aspiration
how may a lower motor neurone lesion cause impaired swallowing?
ipsilateral paresis of phaynx, layrnx and tongue causing weak bolus propulsion tf failed airway closure->aspiration
fix for failed airway closure due to lower motor neurone lesion (excised acoustic neuroma-tumour removal from brain)
head rotation to direct bolus down strong side of pharynx and airway closure
describe the impaired swallowing in parkinsons disease
-typical repetitive tongue movement linked with muscle rigidity -> unable to lower the back of tongue + struggle with swallowing
fix for impaired swallowing in Parkinsons disease
active range of motion exercises of lips and tonue
what makes up normal swallowing?
-vocal cords adduct to produce voice and to close airway
-saliva is cleared in asingle swallow and does not accumulate
-water swallowed <1 second
-no residue in pharynx or in trachea
how are the muscles of facial expression grouped?
orbital, nasal and oral
what are the muscles of facial expression innervated by?
Facial nerve VII
What muscles make up orbital group?
corrugator supercilli and the orbicularis oculi (orbital and palpebral)
what muscles make up the nasal group?
procerus and nasalis (transverse and alar part) and depressor septi nasi
what muscles make up the oral group?
a lot
what muscles move the ear?
superior, anterior and posterior auricular
what muscle contract to close eyelid?
(orbital) orbicularis oculi
describe how facial nerve is distributed across the face
divides in the parotid gland and innervates the temporal, zygomatic, buccal, mandibular and cervical (neck) muscles
what is the temporomandiibular joint?
sinovial joint between temporal bone and mandible that allow the opening and closing of mouth (mastication)
what are the muscles of mastication (moving mandible) innervated by?
mandibular division of trigeminal nerve
describe what action predominates when i) jaws slightly opened ii) jaws widely open
i) hinge action predominates ii) hinge and gliding action combined
what are the superficial muscles of mastication?
masseter and temporalis
what are the deep muscles of mastication?
lateral ptyeryoid and medial pterygoid
origin and insertion of masseter
zygomatic arch to lateral surface of ramus and angle of mandible
function of masseter
elevation of mandible (forced closure of mouth)
origin and insertion of temporalis
temporal fossato coronoid process of mandible
function of temporalis
elevation and retraction of mandible
function of temporalis
elevates and retracts mandible
origin and insertion of lateral pterygoid
lateral pterygoid plate (sphenoid bone) to neck of mandible
function of lateral pterygoid
open mouth by depressing and protracting mandible
origin and insertion of medial prterygoid
lateral pterygoid plate + maxilla + palate to angle of mandible
function of medial pterygoid
elevates, protracts and lateral movement of mandible for chewing
how do we know when vagus nerve is fine?
if uvula goes up
what are the 3 muscles of the pharynx?
superior, middle and inferior constrictors
what nerves innervate the sensory function of the muscles of the phaynx?
pharyngeal plexus: glossopharyngeal (IX) and vagus (X)
what nerves innervate the motor function of the muscles of the phaynx?
Vagus (X) and sometimes accessory nerve (IX)
function of muscles of the pharynx
aid swallowing via their coordinated sequential contraction
what are the three salivary glands?
mainly serous: parotid and submandibular
mainly mucous: suplingual
what innervates the parotid gland?
Glossopharyngeal (IX)
what innervates the submandibular gland?
Facial (VII)
what innervates the sublingual gland?
Facial (VII)
what innervates the anterior 2/3 of tongue and their function?
s: mandibular branch of trigeminal (V3) nerve- (lingual nerve)
t: facial (VII) nerve (chorda tympani-> also innervates sublingual)
what innervates the posterior 1/3 of tongue and their function?
s and t: glossopharyngeal (IX) nerve
what nerve allows movement of tongue?
hypoglossal (XII) nerve
what innervates the base of tongue and the epiglottis?
vagus (X) nerve
unami flavour area on tongue
all over
sour flavour area on tongue
sides of tongue
sweet flavour area on tongue
tip of tongue
bitter flavour area on tongue
base of tongue
fix for impaired swallowing in Parkinsons disease
active range of motion exercises of lips and tonue
salty flavour area on tongue
border, tip of tongue
What are the structures involved in tongue musculature?
muscles: tongue, extrinsic (palatoglossus, styloglossus, genioglossus)
nerves: lingual nerve with submadibular ganglion
bone: mandible and hyoid (bottom)
