Lesson 5- Disorders of Deglutition

Question 1

Disorders of Mastication

Answer 1

• reduced range of lateral tongue movement
• reduced buccal tension and buccal scarring
• reduced range of lateral mandibular movement
• poor alignment of mandible and maxilla
• reduced range of vertical tongue movent

Question 2

Preparatory Phase Disorders

Answer 2

• Reduced labial closure
• Reduced tongue movement for bolus formation
• Reduced range of tongue movement to hold a bolus
• reduced oral sensitivity

Question 3

Oral Phase Disorders

Answer 3

• tongue thrust
• reduced tongue elevation
• reduced anterior-posterior tongue movement
• disorganized anterior to posterior tongue movement
• scarred tongue
• reduced buccal tension/scarring
• reduced ability to seal tongue to palate laterally

Question 4

Pharyngeal Stage Disorders

Answer 4

Aspiration, delayed swallowing response, absent swallow response, inadequate V-P closure, reduced pharyngeal wave contraction, unilateral pharyngeal disorders, cervical osteophyte, scarred pharyngeal wall, scar tissue-base of tongue, P-E dysfunction, reduced laryngeal elevation, reduced laryngeal closure,

Question 5

Aspiration can occur in what 3 instances?

Answer 5

before, during, or after swallow

Question 6

What causes aspiration before a swallow

Answer 6

insufficient closure of oral cavity during preparatory phase OR inability to start the swallow reflex when contrast enters the pharynx

Question 7

What causes aspiration during a swallow

Answer 7

insufficient closure of the larynx

Question 8

What causes aspiration after a swallow

Answer 8

stasis in the pharynx–when larynx opens it leaks into the trachea

Question 9

What mastication disorder would make it difficult to move food onto the teeth

Answer 9

reduced range of lateral tongue movement

Question 10

What mastication disorder would cause food to collect in sulci and is common after CVA and CA surgery

Answer 10

reduced buccal tension and buccal scarring

Question 11

What mastication disorder caused food to fall uncontrolled throughout the oral cavity and may cause the bolus to be aspirated prior to the swallow before swallow response is initiatied

Answer 11

reduced range of vertical tongue movement

Question 12

What preparatory phase disorder causes oral containment issues

Answer 12

reduced labial closure

Question 13

What preparatory phase disorder causes spreading of the bolus throughout the oral cavity and the bolus may fall over base of tongue into an unprotected airway

Answer 13

reduced tongue movement for bolus formation

Question 14

What oral phase disorder may push food from the mouth and cause a shift of central incisors

Answer 14

tongue thrust

Question 15

What oral phase disorder may cause restricted movement and result in increased oral transit times, tongue to palate pressure changes, the bolus to be spread throughout the mouth, or chance of aspiration prior to the swallow

Answer 15

reduced tongue elevation

Question 16

what oral phase disorder slows bolus movement and results in stasis in the lateral sulci

Answer 16

reduced anterior-posterior tongue movement

Question 17

What oral phase disorder causes tongue pumping and the back of tongue remains elevated

Answer 17

disorganized anterior to posterior tongue movement

Question 18

What oral phase disorder is common with oral Ca, has depression in the tongue, and material collects in the depression

Answer 18

scarred tongue

Question 19

What oral phase disorder causes residue in the lateral sulcus

Answer 19

reduced buccal tension/scarring

Question 20

What oral phase disorder causes stasis in sulci

Answer 20

reduced ability to seal tongue to palate laterally

Question 21

What pharyngeal phase disorder results in the risk of penetration/aspiration BEFORE the swallow and premature spillage to the valleculae/pyriforms

Answer 21

delayed swallowing response

Question 22

What pharyngeal phase disorder results in the bolus remaining in the pharynx/sinus cavities, and poses a great risk of aspiration, and the bolus will eventually be aspirate or expectorated

Answer 22

absent swallowing response

Question 23

Which pharyngeal phase disorder is common after oral Ca, and is characterized by the following: soft palate does not close automatically, may close too late, bolus flows into the nasal cavity

Answer 23

Inadequate V-P closure

Question 24

Which pharyngeal phase disorder is common after oral Ca, following radiation treatment, or muscular/neuromuscular disorders and is characterized by the following: residue in sinsu cavities and /or throughout the pharynx, may not be a delay in response, risk of aspiration of residue

Answer 24

reduced pharyngeal wave contraction

Question 25

Unilateral Pharyngeal disorders

Answer 25

difficulty with peristalsis and cricopharyngeal musculature on one side, residue on one side, best observed on A-P view, head turning to weak side may help

Question 26

What pharyngeal stage disorder is characterized by boney outgrowth from anterior surface of the cervical vertebra and narrows the pharynx and may restrict passage of the bolus

Answer 26

cervical osteophyte

Question 27

What pharyngeal stage disorder effects movment of pharyngeal constrictors and may have resulted from Ca resection, healed fistulas…and may form a pouch and collect food or liquid, and has risk of residue being aspirated

Answer 27

scarred pharyngeal wall

Question 28

What pharyngeal stage disorder is only seen after laryngectomy and may result in a pseudo epiglottis and can close the pharynx and the bolus comes back into the mouth or nasal cavity

Answer 28

scar tissue-base of tongue

Question 29

What pharyngeal stage disorder is characterized by the PE segment being contracted at rest, but relaxes with larynx elevation, and the inability to relax or mistiming results in residue with possible aspiration

Answer 29

P-E dysfunction

Question 30

What pharyngeal stage disorder may compromise airway closure and result in aspiration and may result in the bolus entering the glottis and being aspirated FOLLOWING the swallow

Answer 30

reduced laryngeal elevation

Question 31

What pharyngeal stage involves the epiglottis/ false vocal folds/ or true vocal folds and may and results in aspiration DURING the swallow even though all else may be normal. (TVC of unequal height may be an issue)

Answer 31

reduced laryngeal closure