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Dysphagia > Normal Swallow > Flashcards

Normal Swallow Flashcards

1
Q

4 phases of the swallow

A

Oral prep, oral, pharyngeal, esophageal

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2
Q

Beginning/end of oral prep phase

A

beginning: when bolus enters the mouth, end: when the bolus is pushed to the roof of the mouth by the tongue

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3
Q

Important anatomy of the oral prep phase

A

tongue (most important), lips, the jaw

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4
Q

Muscles of mastication and oral preparation of the bolus (oral prep phase)

A

5 paired muscles: temporalis, masseter, lateral pterygoid, medial pterygoid (all are muscles of mastication), buccinator (responsible to keep the bolus taught/retain pressure in your mouth)

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5
Q

Describe the oral prep phase:

A

the bolus enters the mouth, the tongue moves laterally, muscles of mastication and jaw create a rotary chew, chew is voluntary at first then becomes reflexive, saliva helps turn the food into a bolus, bolus is centralized and compressed by the tongue and pressed against the hard palate

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6
Q

Describe the oral prep phase with CN innervation:

A

Open your mouth (CN 5), move food laterally to the teeth and chew (CN 5), centralize the bolus as it mixes with saliva (CN 7) and move it up to the roof (CN 12)

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7
Q

Chewing begins as ____ but then becomes ____

A

voluntary, reflexive

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8
Q

3 sets of salivary glands

A

submandibular (underneath the jaw), parotid (top of the teeth), sublingual (under the tongue)

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9
Q

Why is saliva needed

A

saliva starts the digestion process, adds liquid to the bolus to make it more cohesive /manageable, keeps our mouth clean

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10
Q

Beginning/end of oral phase

A

beginning: when bolus begins anterior-posterior movement after being pressed against the roof of the mouth, end: when bolus reaches the oropharynx

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11
Q

Buccinator function

A

Tighten cheeks to molars (CN VII)

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12
Q

Temporalis function

A

lifts and retracts jaw (CNV3)

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13
Q

Masseter function

A

elevates jaw (CNV3)

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14
Q

Lateral pterygoid function

A

side-to-side (CN V3)

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15
Q

Medial pterygoid function

A

elevation (CN V3)

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16
Q

The border between oral prep and oral phase is iffy. What is one landmark that separates the two:

A

Faucial Pillars

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17
Q

Describe the oral phase

A

the bolus moves from the roof of the mouth (hard palate) posteriorly towards the hypopharynx, velum raises

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18
Q

Main CN innervation during the oral phase:

A

CN XII innervates the muscles of the tongue to help with A>P propulsion

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19
Q

Intrinsic muscles of the tongue (4):

A

superior longitudinal muscle, transverse muscle, vertical muscle, inferior longitudinal muscle

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20
Q

Extrinsic muscles of the tongue (3 important ones):

A

palatoglossus muscle, styloglossus muscle, genioglossus muscle (and hyoglossus)

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21
Q

Superior longitudinal muscle

A

(intrinsic muscle) runs back to front. Meant to shorten the tip of your tongue (raise tip) and create concave depression

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22
Q

Transverse muscle

A

(intrinsic muscle) underneath the superior longitudinal muscle, responsible for elongation and narrowing

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23
Q

Vertical muscle

A

(intrinsic muscle) underneath the superior longitudinal muscle, responsible for flattening the tongue

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24
Q

Inferior longitudinal muscle

A

(intrinsic muscle) bottom of the tongue. shorten tongue/depress tip. Putting the tongue behind the teeth

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25
Palatoglossus muscle
(extrinsic muscle) moves the tongue towards the palate. Helps raise the tongue
26
Styloglossus muscle
(extrinsic muscle) responsible for lifting the posterior portion of the tongue and pulling it backwards (elevating and retracting)
27
Genioglossus muscle
(extrinsic muscle) connects to the hyoid bone and lifts everything in the larynx
28
2 jobs of the pharyngeal phase
airway protection and bolus propulsion
29
Beginning of the pharyngeal phase
bolus passes into oropharynx, swallow trigger is activated
30
End of pharyngeal phase
bolus passes through UES
31
6 things that happen during pharyngeal phase:
velopharyngeal closure, inversion of epiglottis, hyolaryngeal excursion, VF close, progressive contraction of the pharyngeal muscles, opening of the UES
32
Describe what happens during the pharyngeal phase:
bolus passes the faucial pillars and the swallow trigger is activated. The velum raises while the tongue reaches back to touch the back pharyngeal wall and create pressure. The laryngeal vestibule collapses in on itself while hyolaryngeal excursion is happening (elevation and anterior movement of the hyoid bone and larynx). The True VF close and the epiglottis inverts to protect the airway. The pharyngeal contraction muscles squeeze from top to bottom. The UES opens and the bolus passes through
33
CN Innervation in the pharyngeal phase
sensory information about the bolus come from CN VII, IX, X. sensory information is bolus-dependent. Motor information (used to decide how to move/process) comes from CN IX, X, XI
34
During hyolaryngeal excursion the hyoid bone moves more superiorly or anteriorly?
Anteriorly
35
During hyolaryngeal excursion the larynx moves more superiorly or anteriorly?
Superiorly
36
T/f: the pharyngeal contraction muscles are peristaltic?
F: They're not a complete ring
37
t/f: the steps in the pharyngeal phase happen in the same order every time
false (it changes depending on the characteristics of the bolus)
38
what muscle is most responsible for elevation of the hyoid bone (during hyolaryngeal excursion)
Mylohyoid
39
muscles responsible for elevation of the hyolaryngeal complex
suprahyoid muscles: digastric, geniohyoid, mylohyoid, deep pharyngeal muscles: palatopharyngeus, stylopharyngeus
40
t/f: the distance the hyolaryngeal complex raises during excursion is much shorter than the distance it moves forward
T
41
3 things that happen to protect the airway:
inversion of the epiglottis, VF closing (true and false VF), laryngeal vestibule collapses (collapse happens due to hyolaryngeal excursion, aka it is being moved up and forward so the 'triangle' can't stay as a triangle)
42
t/f: complete closure of the true VF happens by the time the hyoid reaches its maximum elevation
T
43
Where are the valecullae located
The space between the epiglottis and base of the tongue
44
Where are the pyriform sinuses located?
At the top of the UES towards the back, in rest it is closed but will expand to hold leftover bolus during swallow
45
3 muscles of pharyngeal constriction:
superior constrictor muscle, middle constrictor muscle, inferior constrictor muscle. Innervated by CN X, XI
46
The pharyngeal phase of the swallow is completed with the support of 2 forces. What are they
mechanical (anatomy doing its thing to move the bolus down) and pressure
47
3 things that need to happen for the UES to open:
deinnervation of the muscle (aka relax the muscle), the plunger effect (pressure above), and hyolaryngeal excursion pulls on the front of the muscle to assist in opening. (bonus #4 when the UES opens the negative pressure below sucks the bolus down)
48
Beginning and end of esophageal phase:
Passing through UES; Passes through LES
49
Describe what happens in the esophageal phase
bolus passes through UES, 3 portions of the esophagus contract with peristalsis to push the bolus down through the LES
50
t/f: UES/PES/CP all mean the same thing
T
51
t/f: the LES is a true sphincter
T
52
t/f: the LES stays in a tonic state
T
53
Striated muscle fibers
fast, quick, small muscle fibers. voluntary or skeletal muscle (primarily voluntary). Type of fibers most commonly activated or moved during voluntary movement
54
Smooth muscle fibers
slow, free, want to stay relaxed. Involuntary muscles of internal organs. Typically move as a result of involuntary movement (such as digestion)
55
esophageal body is made up of 4 tissue layers:
mucosa (innermost layer), lamina propria (lubricates esophagus to help bolus move), musclular mucosa (striated/smooth muscle fibers live here), submucosa
56
3 waves of peristalsis
primary waves, secondary waves, tertiary waves
57
Primary waves of peristalsis
initated by pharyngeal swallow, pressures during pharyngeal phase of swallow push the bolus down
58
Secondary waves of peristalsis
normal waves, not initiated by swallow. Result from presence of a bolus (!!)
59
Tertiary waves of peristalsis
mostly in older adults, happen at same time as first 2 waves. Can be mild or severe enough to cause dysphagia
60
3 primary sections of the esophagus:
cervical, thoracic, abdominal
61
Cervical portion of the esophagus:
most superior, striated muscle
62
Thoracic portion of esophagus
middle, mixed muscle
63
Abdominal portion of the esophagus:
most inferior; smooth muscle
64
About how many second after the esophageal stages has begun does the LES begin to relax?
2 seconds
65
the esophageal stage takes ___ seconds
8-20
66
why are the "phases" of the swallow incorrect?:
all the stages affect each other, there is lots of variation during a real-time swallow. The system is integrated and dynamic.
67
bolus characteristics
volume/size, consistency/viscosity, temperature, taste
68
SwallowER variables
age, sex, size, position, individual differences
69
Changes in swallow when you age
tissues become thicker and more rigid, elasticity reduces, fat and connective tissues replace ones that were muscle-filled, sensory receptors reduced in number, sensory and motor fibers conduct slower, larynx descends in the neck with age
70
Changes in swallow depending on sex
distance of hyoid elevation, duration of UES opening, amount of pharyngeal area, duration of swallowing apneic period
71
t/f: persons with respiratory problems may have altered breathing/swallowing patterns
T
72
Time we hold our breath
Apneic Period

Dysphagia (9 decks)

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