Interim 1 Flashcards
Define dysphagia
Dysphagia is an abnormality in the transfer of a bolus from the mouth to stomach, including abnormalities in the oral preparatory, oral, pharyngeal and/or esophageal stages
Define feeding disorder
A feeding disorder is
an impairment in the process of food transport outside of the alimentary system, e.g., weakness or incoordination of the arm to move food from the plate to the mouth
List overt characteristics of dysphagia
Difficulty chewing Difficulty with bolus preparation Drooling Choking Regurgitation Sense of food sticking in throat Pain
List occult or covert characteristics of dysphagia
Silent laryngeal penetration and aspiration
Define incidence rate
number of new cases of a disease over a period of time divided by population at risk of the disease in the time period
Define prevalence rate
total number of cases of a disease at a given time divided by total population at risk at a given time
List consequences of dysphagia
Aspiration pneumonia Malnutrition >>> weight loss, poor healing, susceptibility to other illnesses Dehydration Airway obstruction Death Decreased quality of life Health care costs
List the stages of swallowing
Oral preparatory
Oral
Pharyngeal
Esophageal
What is the relevance of bony structures in relation to speech/swallow?
Bony structures are anchor points for muscles involved in speech/swallow
List structures included in a visual inspection of the oral cavity
Lips Sulci Gums Dentition Faucial pillars Roof of mouth Tongue Posterior pharyngeal wall
List the points of attachment for muscles associated with bolus preparation/propulsion
Temporal bones Sphenoid bone Maxillae Mandible Palatine bone
Describe the temporal bones
Form lateral sides of the cranium
Forms footing for the temporomandibular joint
Has three processes which are important attachment sites for muscles used during swallow
Describe the sphenoid bone
Located deep within cranium
Bat-shaped
Attachment sites for several muscles associated with swallowing
Give characteristics of the facial skeleton
Comprised of the maxillae and mandible Anchor sites for dentition Attachment sites for muscles of facial expression and mastication Vital role in oral stage Grinding food Bolus formation Oral pressure generation
Describe the maxilla
Forms framework for anterior aspect of midface, initial portion of hard palate, inferior surface of orbital cavity, and lateral sides of nasal cavity
Meets zygomatic or cheek bone and adjoined by L-shaped palatine bones
Houses maxillary dentition
Serves as contact point for tongue during oral stage
Describe the mandible
U-shaped
Body, angle, ramus
Has ridges for muscle attachments
Lingual surface: attachment for extrinsic muscles of tongue and muscles of FOM
Describe the temporomandibular joint
Formed by articulation of condylar process of the mandible at the mandibular fossa of the temporal bone
Allows movement in three planes for rotary displacement of jaw
Depression/elevation
Protrusion/retraction
Lateralization
List structures associated with the palate
Palatine processes = three quarters of hard palate
Palatine bone = posterior one-quarter of hard palate
Attachment for palatal aponeurosis
What actions should be analyzed in a swallow study?
Oral phase Tongue-palate seal Nasopharyngeal seal Compression/propulsion of bolus Hyoid/laryngeal elevation Epiglottic tilt Cricopharyngeal opening Esophageal peristalsis
What structures should be analyzed in a swallow study?
Tongue Hard palate Velum Epiglottis Hyoid/larynx Pharyngeal constrictors Cricopharyngeus/UES Esophagus
List normal actions that occur in the oral phase
Lips engulf bolus
Bolus is held at rest in front of mouth
Masticate if needed
Tongue transfers bolus into pharynx
Describe a typical tongue-palate seal
Soft palate rests against posterior tongue blade without kinking
Describe a typical soft palate-pharyngeal seal
Soft palate elevates to appose Passavant’s cushion
Describe typical bolus compression and propulsion
Retraction of base of tongue
Progressive contraction of constrictors
Describe typical hyoid elevation, laryngeal closure, and epiglottic tilt
Larynx moves upward and forward as bolus enters oropharynx
Epiglottis moves horizontally
Epiglottis inverts
Airway is protected by “triple action”
Describe typical actions of the cricopharyngeal opening
Closed between swallows
Relaxes and opens completely to allow bolus to flow form pharynx into esophagus
Describe the typical action of the esophagus
Peristalsis
List atypical actions of the esophagus
Dysmotility
Reflux
Spasm
List characteristics involved in esophageal dysphagia
Stenosis (rings, webs, stricture, tumor, extrinsic compression)
-Solid food dysphagia
-Liquid dysphagia preceded by solid food ingestion
Diverticula
-Retention
-Regurgitation
-Halitosis
List characteristics of structural abnormalities
Is a structure: Resected/absent Replaced Altered in some way Thickened Asymmetric Too large/too small Is there something there that shouldn’t be? Pouch Diverticulum Mass Foreign body Fistula
Describe the pharynx
Suspended from base of skull and attached to the top of sternum
Contiguous with oral cavity, palate, tongue, nasal cavity, eustachian tube
Formed by 26 pairs of striated muscles
Innervated by six cranial nerves and four cervical nerves
Describe the nasopharynx
Extends from base of skull to pharyngeal isthmus
Demarcated by soft palate anteriorly and by a prominence in the posterior wall at first cervical body
Lies above velum
Describe the oropharynx
Extends inferiorly from BOT to hyoid
Bordered by tongue anteriorly and by pharyngeal constrictors posteriorly
Separated from oral cavity by faucial arches
Describe the hyppharynx
Extends from valleculae to pharyngo- esophageal segment (PES) inferiorly
Larynx forms the anterior wall
Define pharyngeal constrictors
Fibers arise from median raphe in the midline of the posterior pharyngeal wall and run laterally to attach to bony and soft tissue structures anteriorly
Comprise external circular layer
List the functions of the pharyngeal constrictors
Constrict or reduce the diameter of pharynx
Clear bolus through pharynx
Name the pharyngeal constrictors
Superior Glossopharyngeus Middle Hypopharyngeus Inferior Thryopharyngeus Cricopharyngeus
Describe the internal longitudinal layer
Salpingoharyngeus Draws lateral wall of pharynx up Palatopharyngeus Draws muscular palate down Stylopharyngeus Elevates pharynx and to some extent larynx
Define vallecula
Lateral recesses at the BOT on each side of epiglottis
Give characteristics of the epiglottis
Extends from BOT into pharyngeal cavity
Attached to thyroid notch by a ligament
Deflects bolus stream laterally into pyriforms
Epiglottic folding occurs by laryngeal elevation, increased pressure in preepiglottic fat space, weight of bolus
Describe the pyriform sinuses
Lateral recesses between larynx and anterior hypopharyngeal wall
Formed by attachment of inferior constrictors to thyroid cartilage
Describe the cricopharyngeus
Lies at transition between pharynx and esophagus Acts as a sphincter Tonic contraction at rest Relaxes during swallowing Inserts on cricoid and encircles pharynx
Describe the larynx
Anterior to hypopharynx at upper end of trachea Cartilaginous Hyoid Thyroid Cricoid
List and desribe structures located in the larynx
Arytenoids are true synovial joints Positioned on rim of cricoid
Laryngeal aditus
Uppermost portion of entry to airway
Laryngeal vestibule
Supraglottic space between aditus and ventricular or false vocal folds
False vocal folds
Shelf of tissue
Separate laryngeal vestibule and ventricle
Laryngeal ventricle
Inferior margin is true vocal folds
True vocal folds
Composed of vocalis and thyroarytenoid muscles
Attached from the vocal processes of the arytenoids posteriorly to the inside surface of thyroid lamina laterally and to the thyroid notch laterally
Describe extrinsic musculature
Elevate hyoid Suprahyoid muscles Geniohyoid Mylohyoid Digastric Stylohyoid Depress hyoid Infrahyoid muscles Thyrohyoid Sternohyoid Sternothyroid Omohyoid
Describe intrinsic musculature
Abduction Posterior cricoarytenoid Adduction Thryoarytenoid Lateral cricoarytenoid Transverse and oblique arytenoid Thyromuscularis Cricothyroid Only laryngeal muscle supplied by the external branch of the superior laryngeal nerve rather than the recurrent laryngeal nerve
Give characteristics of false vocal folds
Outcroppings of mucosal tissue Not muscular structures Adducted when the arytenoid cartilages are displaced medially and anteriorly Oblique interarytenoids Aryepiglottic muscle
Give characteristics of the esophagus
Collapsed muscular tube 18-25 cm Upper third Striated Controlled by CNS Middle third Combination of striated and smooth Lower third Smooth Controlled by ANS
List the muscles of the esophagus
Exterior
Longitudinal muscles
Interior
Circular muscles
Define peristalsis
Constriction by contraction of circular muscles
Shortening by contraction of longitudinal muscles
Describe the upper esophageal sphincter
High pressure zone between pharynx and esophagus
Formed by
Cricopharyngeus
Inferior fibers of inferior constrictor
Superior portion of longitudinal esophageal musculature
Describe the lower esophageal sphincter
Junction between esophagus and stomach
Maintains resting tone to prevent regurgitation
Opens to permit liquid or food into stomach
List the cranial nerves involved in speech and swallow
Trigeminal V Facial VII Glossopharyngeal IX Vagus X Accessory XI Hypoglossal XII
Trigeminal nerve
Largest cranial nerve
Has three divisions
Ophthalmic (sensory)
Maxillary (sensory)
Mandibular (motor and sensory)
Motor to muscles of mastication, tensor tympani, tensor veli palatini, anterior digastric, mylohyoid
Sensory for eyes, nose, maxillary sinus, head, face, mouth, teeth, oral tongue
Facial nerve
Motor to facial muscles, platysma, buccinator, stapedius, posterior belly of digastric, stylohyoid
Sensory to anterior two-thirds of tongue and soft palate
Motor autonomic to submandibular and sublingual glands
Glossopharyngeal nerve
Motor to stylopharyngeus and PES
Sensory to oropharynx and posterior third of tongue
Parasympathetic to parotid
Vagus nerve
Superior laryngeal nerve
Sensory to epiglottis, supraglottis, hypopharynx, posterior larynx, pyriforms
Inferior or recurrent laryngeal nerve
Motor to intrinsic laryngeal muscles, PES
Motor to heart, lungs, bronchii, GI tract, pharynx, BOT, larynx
Sensory to heart, lungs, bronchii, trachea, larynx, pharynx, GI tract, external ear
Accessory nerve
Cranial portion
Motor to pharynx, upper larynx, uvula, palate
Sends fibers to recurrent laryngeal nerve and cardiac nerves
Spinal portion
Motor to upper portion of sternocleidomastoid and trapezius muscles
Sends branches to C 2-4
Hypoglossal nerve
Motor to tongue and strap muscles of neck
List atypical features of the oral phase
Drooling (anterior loss of bolus) Poor bolus formation Multiple tongue movements Prolonged oral stage Difficulty initiating a swallow Unable to propel bolus posteriorly Reduced lingual movement Failure to obliterate oral cavity Loss of bolus into FOM Loss of bolus through lips Pooling or pocketing Oral residue Asymmetry of bolus at rest
Characterize abnormal features of a tongue-palate seal
Kinking of soft palate
Loss of bolus over tongue
Premature leakage
Potential for aspiration
Describe atypical features of the soft palate-pharyngeal seal
Sluggish elevation of the soft palate
Nasopharyngeal regurgitation
Dependent on strength of seal and inferior constrictors
Give abnormal features of bolus compression and propulsion
Diminished constriction
Failure of lateral pharyngeal walls to come to midline
Unilateral asymmetry
Retention in vallecula and/or pyriforms
List abnormal actions involved in hyoid elevation, laryngeal closure, and epiglottic tilt
Absent or diminished hyoid to mandible apposition Incomplete or absent epiglottal tilt Vallecular retention Vocal folds open during swallow Laryngeal penetration/aspiration
Describe abnormalities in the cricopharyngeal opening
Opens late or incompletely
Closes early
Cricopharyngeal prominence or “bar”
Trapping of bolus
