Normal swallow physiology

Question 1

What are the four stages of swallowing?

Answer 1

Oral prep, oral transit, pharyngeal, esophageal

Question 2

What are the steps of the oral prep stage?

Answer 2

tongue holds bolus on teeth, food masticated, oral seal keeps bolus contained

Question 3

What is the mouth like during the oral prep stage?

Answer 3

closed, cheeks tight against gums, tongue holding bolus on teeth

Question 4

Which CNs are involved in the oral prep stage?

Answer 4

CN V Trigeminal (sensory to tongue – where is the bolus), CN VII Facial, CN XII, Hypoglossal

Question 5

What is necessary for mastication?

Answer 5

adequate dentition, alertness, awareness of bolus, sensory feedback

Question 6

what is the tipper position?

Answer 6

liquid cupped on tongue

Question 7

What is the dipper position?

Answer 7

liquid in mouth in front of tongue

Question 8

What is considered the starting point for the pharyngeal swallow?

Answer 8

superior and anterior hyolaryngeal movement

Question 9

pharyngeal stage of swallow characterized by what?

Answer 9

pharyngeal movement, NOT bolus position

Question 10

Where is the traditional area where the pharyngeal swallow starts?

Answer 10

area between anterior faucial arches and the point where the tongue base crosses the lower rim of the mandible, but it can occur before or after these points in healthy individuals

Question 11

If the bolus is in the pharynx, but there is no pharyngeal movement, what do we call that?

Answer 11

absent pharyngeal swallow

Question 12

What are the events of the pharyngeal stage?

Answer 12

laryngeal closure, tongue base retracts, superior and anterior hyolaryngeal movement, velum raises and closes off nasopharynx

Question 13

How does the larynx close?

Answer 13

from bottom to top – vocal folds close, false folds close, arytenoids are together and tilt anteriorly, epiglottis inverts to fold over the arytenoids

Question 14

how does the tongue participate in the pharyngeal phase?

Answer 14

posterior tongue delivers the bolus to the pharynx
tongue base retracts posteriorly to contact the posterior pharyngeal wall, which increases the pressure on the bolus and helps push it down
tongue base traverses about 2/3 of the distance and the pharyngeal wall traverses about 1/3 to make contact

Question 15

How is the hyoid bone pulled superiorly and anteriorly during the pharyngeal stage of swallowing?

Answer 15

suprahyoids contract

Question 16

What also happens when the hyoid bone is pulled up and forward?

Answer 16

larynx moves up, epiglottic inversion, pulls PES open

Question 17

Velar closure helps make sure food doesn’t get into the nasopharynx. What else does velar closure help with?

Answer 17

helps pressure build up in the pharynx to aid swallow.

Question 18

What is the purpose of primary and secondary peristalsis?

Answer 18

primary: get the food downnn
secondary: clear residue left in esophagus