Module 2

Question 1

Normal Swallowing

Answer 1

Deglutition = act of swallowing
Muscles are activated in a distinct sequence
Triggered by volitional cortical drive or peripheral sensory input
Both voluntary (eating) and involuntary (sleeping) muscular contractions
Timing movement depends on consistency

Question 2

Once swallow is initiated, there is a cascade of sequential muscle activation
Efficient swallow depends on

Answer 2

the strength of the neuromuscular contraction, as well as gravity
Bolus (high area of positive pressure) passes to zones of negative pressure
This transfer of pressure pulls the bolus downward

Question 3

Use lips, palate, airway closure, UES to create these zones

Answer 3

When these pressure zones are not adequately balanced, problems arise

Question 4

No two people swallow exactly the same

Answer 4

No one person swallows each bolus (even if same consistency) the same

Question 5

1 Oral Preparatory

Answer 5

….is the reason why we eat. What taste good.
Break down food
Make bolus turn into a ball
Mix it with saliva for preparation to swallow
Voluntary

Question 6

What happens during oral prep?

Sensory:

Answer 6

Taste, temperature, touch (consistency)
Lip seal: prevents anterior spillage
Mastication
rotary chew: grindding motion of teeth (adult)
lateral tongue movements (moves bolus to molar table)
mandibular excursion: Jaw moving up and forward

Question 7

The tongue works to:

Answer 7

Bolus manipulation (movement of food posteriorly)
Bolus formation and cohesion
Bolus hold
front and center by tongue against hard palate
require a strong tongue
Ultimately prepares and transfers the bolus into the oropharynx- thus signaling the onset of the oral stage

Question 8

Posterior aspect of tongue is elevated

Answer 8

to keep thing from going down windpipe
Soft palate is forward against tongue
to keep stuff out nose

Question 9

Sensation of taste

Answer 9

The primary receptors for taste on the tongue are activated by saliva.
General sensation (not related to taste) of the tongue is mediated by CN V (mandibular branch)
Required for taste and bolus formation
I need to be able to feel where the food is in my mouth

Question 10

Salivary Glands

Answer 10

submandibular, submaxillary and parotid salivary glands

These glands are activated by movements of the jaw, tongue, and hyoid bone during bolus prep

Question 11

What about oral hygiene?

Answer 11

Reduced salivary gland function tend to have poorer oral hygiene
bc you need moisture in your mouth to get rid of natural bacteria in mouth

Question 12

Random facts (Oral PreP)

Answer 12

Airway is open
Larynx is at rest
\Timing movement depends on consists

Question 13

2. Oral Stage

Answer 13

Purpose is to deliver the prepared bolus into the pharynx and trigger the swallowing response.
Tongue…… in the oral stage
Propels food posteriorly
Tongue moves upward and backward contacting posterior pharyngeal wall and eventually the soft palate (up and back )
VP port closure (UP)
Swallowing response is triggered
Tip and dorsum work to contain bolus
Posterior tongue pushes bolus down into pharynx
Applies positive pressure to bolus by contacting soft palate and posterior pharyngeal wall

Question 14

nerves used in oral phase

Answer 14

CN V, IX for tongue sensation
CN VII and IX for taste
CN IX gag
CN X (SLN) base of tongue, swallow initiation
Oral phase lasts ~ 1 second
Beginning of nasopharyngeal and airway closure – respiration ceases

Question 15

Swallow Arnea

Answer 15

Normal respiration and swallow
Inhale, Exhale, Swallow, Exhale, Inhale, etc…
If the patient ids already having trouble breathing don’t feed them
Duration of swallow apnea depends on bolus size and age (0.75 – 1.25 seconds)
Small exhalation after the swallow is yet another way the body protects its airway

Question 16

3. Pharyngeal Stage

Answer 16

Purpose is to deliver the bolus safely through the pharynx and into the esophagus

Question 17

Physiologically the most important (Stage 3)

Answer 17

Begins with triggering of the swallow response

Involuntary

Question 18

Briefly: All happens at the same time (Stage 3)

Answer 18

The soft palate completes closure
Base of tongue retracts
The hyoid bone moves up and forward
—–This helps pull the larynx up and forward (tilts under base of tongue to help protect airway)
The vocal cord close
The epiglottis tilts forward
The tongue pushes backward and downward, assisted by the pharyngeal walls which are pushing inward
The UES opens/ relaxing
Downward propulsion of bolus by muscle contraction and act of gravity
Airway protection
Opening of esophagus / Relaxation of the UES
Pharyngeal constrictors work to narrow and shorten the pharynx
— – this contributes to pharyngeal peristalsis: wavelike movement
Divided bolus (at the velecular space) rejoins itself in the pyriforms as it enters the esophagus

Question 19

Sensation (pharynx)

Answer 19

1. Superior laryngeal nerve (branch of CN X) detects any penetration/aspiration to elicit a cough reflex
2. CN IX (glossopharyngeal) detects bolus in pharynx
   Taste receptors in laryngeal vestibule (SLN) when you split uo and then swallow it before it get to your mouth
   thats why you taste it

Question 20

fun facts about stage 3

Answer 20

Lips are closed (oral cavity is sealed)
VP port is closed
Larynx is closed
CP segment opens

Question 21

What carries the bolus through phenix

Answer 21

Changes in pressure
Base of tongue retraction
Pharyngeal contractions
The lynx is closed ( by moving up and forward) 
Arytenoids begin to close (up and forward)
TVF: close 
FVF: close
Epiglottis tilts down

Question 22

Another way to say it (food moving down pharynx)

Answer 22

Elevation/anterior displacement of larynx
TVF close as arytenoids tilt up and forward
BOT moves posteriorly as FVF close and AE folds move medially
Epiglottis closes laryngeal vestibule
Epiglottic tilt
Pull of muscle forces
Bolus pressure from above
Combined pressure of tongue base moving posteriorly and larynx elevating folds epiglottis down

Question 23

Extent of epiglottic

Answer 23

displacement depends on
Hyoid anterior displacement
Base of tongue retractions
Bolus size
Epiglottis

Question 24

Epiglottis and base of tongue for the vallecular space

Answer 24

This space helps deflect the bolus away from the airway and serves as an additional component of airway protection

Question 25

CP Opening

Answer 25

Traction force of hyoid on the larynx
Upward/forward movement of the larynx
Propulsion force of bolus

Question 26

UES dilates/opens

Answer 26

Begins at nasopharynx
Ends at CP segment
Length of pharyngeal stage
800 ms (

Question 27

4. Esophageal Stage

Answer 27

Purpose is to carry the bolus into the stomach
Involuntary
Can usual wash it down with liquid if you get something stuck

Question 28

During stage 4

Answer 28

UES relaxes, allowing the bolus to enter the stomach
Larynx lowers (returns to resting position)
CP segment closes
Bolus passes through esophagus
Breathing resumes
Esophageal Peristalsis
	Aided by gravity
	Primary/secondary peristalsis
	Primary: triggered by

Question 29

nerve involved in stage 4

Answer 29

CN X
Tertiary contractions
Esophageal distention up to 3 cm: blow up to

Question 30

in stage 4 LES

Answer 30

opens to receive bolus

Question 31

Where is the esophagus

Answer 31

Vertebral levels from UES ~C4/5 to the stomach ~T12
Remains closed as rest
Runs behind the trachea and heart
Composed of both striated and smooth muscles

Question 32

UES

Answer 32

Bundle of muscles at the top of the esophagus
These muscles under conscious control to some extent
breathing, eating, belching, and vomiting
Keep food and secretions from going down the windpipe

Question 33

LES

Answer 33

Bundle of muscles at the lower end of the esophagus, where it meets the stomach
When closed, it prevents acid and stomach contents from traveling backwards from the stomach
LES muscles are not under voluntary control.
3 seconds for liquids
9 seconds for solids
Can range up to 20-30 seconds for completion

Question 34

FEES:

Answer 34

You are looking a a super view

greater phyrgeal stage