Module 2 Flashcards
Normal Swallowing
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
Once swallow is initiated, there is a cascade of sequential muscle activation
Efficient swallow depends on
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
Use lips, palate, airway closure, UES to create these zones
When these pressure zones are not adequately balanced, problems arise
No two people swallow exactly the same
No one person swallows each bolus (even if same consistency) the same
1 Oral Preparatory
….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
What happens during oral prep?
Sensory:
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
The tongue works to:
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
Posterior aspect of tongue is elevated
to keep thing from going down windpipe
Soft palate is forward against tongue
to keep stuff out nose
Sensation of taste
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
Salivary Glands
submandibular, submaxillary and parotid salivary glands
These glands are activated by movements of the jaw, tongue, and hyoid bone during bolus prep
What about oral hygiene?
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
Random facts (Oral PreP)
Airway is open
Larynx is at rest
\Timing movement depends on consists
- Oral Stage
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
nerves used in oral phase
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
Swallow Arnea
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
- Pharyngeal Stage
Purpose is to deliver the bolus safely through the pharynx and into the esophagus
Physiologically the most important (Stage 3)
Begins with triggering of the swallow response
Involuntary
Briefly: All happens at the same time (Stage 3)
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
Sensation (pharynx)
- Superior laryngeal nerve (branch of CN X) detects any penetration/aspiration to elicit a cough reflex
- 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
fun facts about stage 3
Lips are closed (oral cavity is sealed)
VP port is closed
Larynx is closed
CP segment opens
What carries the bolus through phenix
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
Another way to say it (food moving down pharynx)
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
Extent of epiglottic
displacement depends on Hyoid anterior displacement Base of tongue retractions Bolus size Epiglottis
Epiglottis and base of tongue for the vallecular space
This space helps deflect the bolus away from the airway and serves as an additional component of airway protection
CP Opening
Traction force of hyoid on the larynx
Upward/forward movement of the larynx
Propulsion force of bolus
UES dilates/opens
Begins at nasopharynx
Ends at CP segment
Length of pharyngeal stage
800 ms (
- Esophageal Stage
Purpose is to carry the bolus into the stomach
Involuntary
Can usual wash it down with liquid if you get something stuck
During stage 4
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
nerve involved in stage 4
CN X
Tertiary contractions
Esophageal distention up to 3 cm: blow up to
in stage 4 LES
opens to receive bolus
Where is the esophagus
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
UES
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
LES
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
FEES:
You are looking a a super view
greater phyrgeal stage
