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Swallowing > L3 Physiology & Musculature & Shaw Article > Flashcards

L3 Physiology & Musculature & Shaw Article Flashcards

1
Q

The four phases of swallowing are:

A

Oral preparatory, oral transport, pharyngeal, esophageal

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2
Q

The cranial nerves the coordinate swallowing are:

A

CN V, VII, IX, X, XII

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3
Q

The peripheral nerves that coordinate swallowing are:

A

C1, C2, C3

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4
Q

The nerves for swallowing are mediated centrally in the ____________.

A

Swallowing centre of the medulla

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5
Q

The __________ and _____________ stages are also mediated, in particular, by cortical and subcortical regions.

A

Oral preparatory

Oral transport

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6
Q

List 4 examples of consequences of dysphagia.

A

Pneumonia, malnutrition, dehydration, reduced quality of life

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7
Q

The bones that support, stabilize and aid the muscles of mastication are:

A

Mandible, maxilla, hyoid, hard palate, skull (styloid and mastoid processes)

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8
Q

State the functions of the thyroid, cricoid, arytenoid and epiglottic cartilages.

A
  • Provide support for muscles of mastication
  • Lingual and bolus transport
  • Anchor muscles that protect airway as liquid/bolus crosses pharynx
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9
Q

What is an additional function of the epiglottis?

A

Deflect downward to direct bolus into the esophagus, away from the airway

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10
Q

The _______ are for cutting and biting; the _______ are for grinding solid food.

A

Incisors

Molars

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11
Q

The upper aerodigestive tract can be divided into the following 4 spaces:

A

Oral cavity, nasopharynx, oropharynx, hypopharynx

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12
Q

Foods and fluids pass through the ________ and __________, which are smaller spaces within the aerodigestive tract.

A

Valleculae

Pyriform sinuses

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13
Q

What spaces are sealed during the swallow and make no contact with the bolus?

A

Anterior and lateral sulci
Laryngeal vestibule
Laryngeal ventricles

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14
Q

True/False:

Residue in any of the spaces of the upper aerodigestive tract is part of the normal swallow.

A

False – this is indicative of dysphagia

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15
Q

The 3 major pairs of salivary glands are:

A

Parotid, sublingual, submandibular

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16
Q

What are the functions of saliva?

A
  • Helping with bolus formation and transport
  • Promoting oral and dental health
  • Starting the digestive process
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17
Q

What is saliva composed of?

A

Water, electrolytes, enzymes, proteins

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18
Q

The ________ and __________ phases of swallowing are voluntary, while the ________ and __________ phases are involuntary.

A 
Voluntary:
Oral preparatory
Oral transport 
Involuntary: 
Pharyngeal 
Esophageal
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19
Q

The main goal of the oral preparatory phase is:

A

To form a cohesive bolus

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20
Q

True/False:

The oral preparatory phase should only take 3-5 seconds.

A

False – it depends on the texture, viscosity, etc of the food you’re eating

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21
Q

The muscles responsible for sealing the lips and closing off the lateral and anterior sulci are:

A

Orbicularis oris

Buccinator

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22
Q

The ____________ depresses the soft palate toward the base of the tongue to seal off the oral cavity.

A

Palatoglossus

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23
Q

What are the muscles of mastication?

A

Masseter, temporalis, medial and lateral pterygoid

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24
Q

What is the role of the muscles of mastication?

A

Stabilize and actively move jaw during mastication

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25
Q

Where is the bolus contained when mastication is complete:

A

Between the dorsum of the tongue and the hard palate

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26
Q

The _____________ and ___________ transform the tongue’s shape into one with a central groove to better contain the bolus.

A

Transverse intrinsic muscles of the tongue

Genioglossus

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27
Q

True/False:

The oral transport phase of swallowing lasts for 1 second.

A

True (specifically between 0.7 – 1.2 seconds)

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28
Q

True/False:

During the oral transport phase, the orbicularis oris and buccinators are no longer contracted.

A

False – they remain contracted to contain the bolus within the oral cavity

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29
Q

The soft palate is elevated by _____________ and ______________ to seal off the nasal cavity from the oropharynx and create a closed pressure loop.

A

Levator veli palatini

Musculus uvulae

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30
Q

True/False:
During the oral transport and pharyngeal phases, lingual and pharyngeal movements in a rostral/caudal direction generate more high pressure points within a closed loop system.

A

True

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31
Q

At the outset of the oral transport phase, where is the bolus?

A

Between the dorsum of the tongue and the hard palate

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32
Q

What is the purpose of the superior longitudinal muscle during oral transport?

A

Raise the anterior tip and lateral edges of the tongue toward the alveolar ridge

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33
Q

The tongue blade promotes transport of the bolus toward the oropharynx by moving in ____________________.

A

An anterior to posterior wavelike motion.

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34
Q

True/False

The tongue’s wavelike motion occurs because of the activity of the intrinsic muscles alone.

A

False – intrinsic and extrinsic muscles (genioglossus, hyoglossus, styloglossus, palatoglossus, superior longitudinal)

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35
Q

During oral transport, a bulge called ___________ forms in the posterior pharyngeal wall and approaches the rising soft palate.

A

Passavant’s ridge

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36
Q

True/False:

The pharyngeal phase lasts 1 second.

A

True

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37
Q

What event triggers the pharyngeal phase?

A

Bolus crossing over the area of the anterior faucial pillars and the posterior region of the tongue

38
Q

True/False

The pharyngeal phase coincides with the beginning of the depression of the thyroid cartilage.

A

False – elevation of the thyroid cartilage

39
Q

True/False

The texture, taste and volume of food can affect the timing of the swallow trigger in the pharyngeal phase.

A

True – more viscous liquids can delay the trigger while sour foods may initiate an earlier trigger

40
Q

True/False

Respiration ceases during the pharyngeal phase.

A

True

41
Q

The muscles that adduct the vocal folds are:

A

Lateral cricoarytenoid, transverse arytenoid, thryoarytenoid

42
Q

What is the function of the palatopharyngeus, stylopharyngeus and salpingopharyngeus during the pharyngeal phase?

A

Elevate the pharynx (it shortens by 1/3)

43
Q

At the same time that the pharynx is elevated, what else occurs?

A

Tongue base is retracted toward the posterior pharyngeal wall
Pharyngeal constrictors are activated in rostral-caudal direction

44
Q

Pharyngeal constrictor contraction descends from the level of the _________ to the ______________.

A

Nasopharynx

Upper esophageal sphincter (UES)

45
Q

The pharyngeal constrictor contraction is known as ____________ or __________.

A

The pharyngeal stripping wave

Pharyngeal peristalsis

46
Q

What happens as the pharynx elevates?

A

Suprahyoid muscles (mylohyoid, stylohypoid, geniohyoid, anterior and posterior bellies of digastric) direct the hyoid bone superiorly and anteriorly

Thyrohyoid muscle moves the larynx superiorly toward the hyoid

47
Q

Anterior and superior displacement of the hyoid and larynx occurs when the bolus has reached ______

A

The vallecula

48
Q

Why is the anterior and superior displacement of the hyoid and larynx important?

A

Provide airway protection by direction the larynx under the tongue base and by inverting the epiglottis over the laryngeal aditus to direct the bolus away from the laryngeal inlet

49
Q

The laryngeal vestibule is closed by the approximation of _____________ and ______________.

A

Aryepiglottic and ventricular folds

50
Q

How is negative pressure generated to suck the bolus toward the esophagus?

A

Through laryngeal and hypopharyngeal elevation

51
Q

As the larynx and pharynx elevate, they create a biomechanical force that pulls the _________ up and away from the posterior pharyngeal wall, pulling open the __________ and the __________.

A

Cricoid cartilage
Cricopharyngeus muscle
UES

52
Q

The soft palate is pulled down and approximated to the root of the tongue during the pharyngeal phase by the ____________ muscle and by ______________

A

Palatopharyngeus

Posterior pressure of the stripping wave

53
Q

True/False
The cricopharyngeus seals the oropharyngeal cavity while the upper pharyngeal constrictors relax to allow the bolus to enter the esophagus.

A

False – the upper pharyngeal constrictors contract to seal the oropharyngeal cavity; the cricopharyngeus relaxes to permit bolus entry into the esophagus

54
Q

True/False

The opening of the UES creates an additional source of suction.

A

True

55
Q

When does the esophageal phase of swallowing begin?

A

When the bolus passes through the UES

56
Q

How long does the esophageal stage last?

A

6-10 seconds

57
Q

What is the duration of the UES opening?

A

0.5 seconds

58
Q

The UES elevates by about _____ during the swallow.

A

1.5 cm

59
Q

True/False

Relaxation of the cricopharyngeus helps open the UES.

A

True

60
Q

What happens to the cricopharyngeus muscle after the bolus enters the UES?

A

It contracts to seal the esophagus and prevent retrograde bolus entry through there

61
Q

At what rate does peristaltic propagation occur through the UES?

A

2-4 cm/s

62
Q

True/False

The striated muscle of the pharynx and upper esophagus is under voluntary control.

A

False

63
Q

Once peristalsis has begun in the esophagus, the bolus is propelled toward the ________ and the _______.

A

Lower esophageal sphincter (LES) and stomach

64
Q

What happens to the epiglottis, hyoid and larynx when the stripping wave has passed the pharynx?

A

The epiglottis begins to turn upward while the hyoid and larynx descend. Communication with the nasopharynx is re-established.

65
Q

When is the LES triggered to relax?

A

0.5-1.4 second after hypopharyngeal pressure peaks

66
Q

When is the bolus squeezed into the stomach?

A

When the LES relaxes

67
Q

True/False

Peristaltic waves also occur up to an hour after the swallow.

A

True

68
Q

List the 3 bolus driving forces.

A

Lingual driving force
Pharyngeal clearing wave
Hypopharyngeal suction pump

69
Q

True/False

The 3 bolus driving forces move the bolus from a place of negative pressure to positive pressure.

A

False – positive to negative pressure

70
Q

Describe each of the 3 bolus driving forces.

A

Lingual: high to low pressure in anterior to posterior direction
Pharyngeal clearing wave: contraction of contrictor muscles from nasopharynx to oropharynx
Hypopharyngeal suction pump: negative pressure from pulling open UES

71
Q

What is the function of the orbicularis oris?

A

Open, close, invert, protrude lips

72
Q

What is the function of the buccinator?

A

Flatten cheeks, hold food in contact with teeth

73
Q

Name the extrinsic muscles of the tongue.

A

Hyoglossus, genioglossus, styloglossus, palatoglossus

74
Q

Name the intrinsic muscles of the tongue.

A

Superior longitudinal, inferior longitudinal, transverse, verticalis

75
Q

What is the function of the temporalis muscle?

A

Elevate/close/retract mandible

76
Q

What is the function of the masseter?

A

Elevate/close mandible

77
Q

What is the function of the medial pterygoid?

A

Elevate/close mandible

78
Q

What is the function of the lateral pterygoid?

A

Depress/open/protrude mandible, move mandible from side to side

79
Q

What are the muscles of the supralarynx?

A

Mylohyoid, anterior belly of digastric, posterior belly of digastric, stylohyoid, geniohyoid, thyrohyoid, cricopharyngeus, thyroepiglottis

80
Q

State the function and innervation of the mylohyoid

A

CN V; elevates hyoid and tongue, depresses jaw

81
Q

State the function and innervation of the anterior belly of the digastric

A

CN V; depresses jaw, elevates hyoid

82
Q

State the function and innervation of the posterior belly of the digastric

A

CN VII; elevates and retracts hyoid

83
Q

State the function and innervation of the stylohyoid

A

CN VII; elevates hyoid

84
Q

State the function and innervation of the geniohyoid

A

CN XII; draws hyoid up and forward, depresses jaw

85
Q

State the function and innervation of the thyrohyoid

A

CN XII, elevates thyroid cartilage to hyoid, elevates larynx

86
Q

State the function and innervation of the cricopharynxgeus

A

CN X (RLN, SLN); relaxes to open UES

87
Q

State the function and innervation of the thyroepiglottis

A

CN X (RLN); opens/widens laryngeal inlet

88
Q

What are the muscles of the soft palate?

A

Levator veli palatini, tensor veli palatini, musculus uvulae

89
Q

State the function and innervation of the following:
Levator veli palatini
Tensor veli palatini
Musculus uvulae

A

Levator veli palatini – CN X (plexus pharyngeus), raises soft palate

Tensor veli palatini – CN 5, stretches soft palate

Musculus uvulae – CN X (plexus pharyngeus), shortens and raises uvula

90
Q

The muscles of the pharynx that form the external circular layer and the stripping wave are:

A

Superior pharyngeal constrictor, middle pharyngeal constrictor, inferior pharyngeal constrictor

91
Q

What is the function of the internal branch of the superior laryngeal nerve (CN X) in swallowing?

A
  • Ensures that airway is completely closed during swallowing
  • Triggers reflexes that help eject penetrated or aspirated bolus from airway
92
Q

Name and describe 2 reflexes that the internal branch of the superior laryngeal nerve may trigger to eject aspirated bolus from the airway.

A
  • Laryngeal adductor response – triggered by tactile stimulation of laryngeal mucosa; vocal folds involuntarily respond by rapid adduction
  • Laryngeal cough reflex – triggered by tactile/chemical stimulation of larynx/trachea; results in involuntary cough

Swallowing (15 decks)

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