Normal Swallow Stages

Question 1

Oral

Answer 1

often divided into two phases:

• Oral Preparatory Phase
  When food is manipulated in the mouth and prepared for the swallow
• Oral Phase
  When the tongue propels the food posteriorly until the pharyngeal swallow is triggered

Question 2

Pharyngeal Stage

Answer 2

• past the faucial pillars

- when the pharyngeal swallow is triggered and the bolus is moved through the pharynx

Question 3

esophageal stage

Answer 3

When esophageal peristalsis carries the bolus through the cervical and thoracic esophagus and into the stomach

Question 4

sensory recognition component of oral prep

Answer 4

• food approaches mouth
• mouth begins to prepare
• mouth movements depend on type of material (viscosity) ex. solid, liquid, and amount

Question 5

from the time material enters mouth..

Answer 5

labial seal is maintained

-required an open nasal airway and nasal breathing

Question 6

how material is help within the oral cavity

Answer 6

liquid:
-between tongue and anterior hard palate

solid:
-between midline of tongue and hard palate with the tongue tip elevated and contacting the anterior alveolar ridge OR held on floor of mouth in front of tongue

Question 7

tongue thrust

Answer 7

when the bolus is more anteriorly between the tongue and the anterior teeth

(reverse swallow pattern)

Question 8

oral prep phase of deglutition for material

Answer 8

• requires mastication
• involves rotary lateral movements of the mandible and tongue

tongue positions material on teeth, when food is crushed it falls medially toward the tongue. tongue then moves the material back onto the teeth in order to complete mastication (chewing)

Question 9

liquid volume range

Answer 9

1 (saliva)-17/20 (cup drinking) mL

Question 10

solid volume range

Answer 10

5-7 cc (pudding consistency)
3-5 cc for hicker viscosity (mashed potatoes)
2 cc for meat

Question 11

what happens if volume is too large (piecemeal swallow)

Answer 11

tongue will subdivide the food after chewing and only segmented boluses will be swallowed at a time

-holding excess food in your cheeks while you swallow part of what you can then swallow again

Question 12

larynx and pharynx during oral prep

Answer 12

• at rest
• airway is open, nasal breathing continues
• VFs open

It is in this area however that if deficits occur within the oral stage that material may trickle into the pharynx and possibly the open airway

Question 13

oral stages begins when

Answer 13

tongue starts to move the bolus posteriorly

Question 14

oral stage tongue movement

Answer 14

• tongue tip moves upward in a smooth fashion
• midline sequentially squeezed bolus against hard palate
• side and tip remain tightly pressed against alveolar ridge
• buccal musculature is engaged in assisting with propelling of material

Question 15

avg time to complete oral stage

Answer 15

1-1.5 seconds

longer than this is abnormal

Question 16

pharyngeal stage begins when

Answer 16

food passes the faucial pillars

Question 17

triggering the pharyngeal swallow

Answer 17

Sensory receptors in the oropharynx and tongue are stimulated as the tongue moves the bolus posteriorly
- Send messages to the cortex and brainstem

The oral stage of the swallow is terminated and the pharyngeal swallow is triggered (typically)
- When the bolus “bolus head” passes any point between the anterior faucial pillars and the point where the tongue base crosses the lower rim of the mandible

Question 18

relationship between voluntary and reflex

Answer 18

“Both voluntary and reflex components are involved in the normal swallow. Neither mechanism alone is capable of producing swallowing with the regularity and immediacy which is necessary during the normal process of oral feeding” Rouche (1980)

The sensory portion of the pharyngeal swallow is carried out by Cranial nerves IX, X and XI

The motor portion of the pharyngeal swallow is carried out by Cranial nerves IX and X

Question 19

VP closure

Answer 19

Variable from person to person

Involves elements of elevation and retraction of the soft palate, inward movement of the posterior and/or lateral pharyngeal walls and anteriorly bulging adenoid pad

Can functionally swallow with impairment if the tongue base makes contact with the post pharyngeal wall

Question 20

elevation and anterior movement of hyoid and larynx

Answer 20

Hyoid bone and larynx move anteriorly by the pull of the floor of mouth muscles (anterior belly of digastric, mylohyoid, geniohyoid and laryngeal elevator – thyrohyoid)
-Pulls up and forwards

Elevation contributes to closure of the airway entrance and forward movement contributes to the opening of the UES

Question 21

closure of larynx

Answer 21

Is a bottom up process beginning with the true vocal folds and progressing through the laryngeal vestibule
- Clears penetration

Larynx is elevated and pulled forward
- Elevation thickens the base of the epiglottis, assisting in the closure of the laryngeal vestibule

The airway is closed for ~1/3 to 2/3 second during a single swallow

During sequential cup drinking for more than 5 seconds

Question 22

cricopharyngeal opening (series of actions)

Answer 22

• Tension in the cricopharyngeal muscular portion of the sphincter is released
• Laryngeal anterior superior motion is seen to open the sphincter (o.1) seconds later
• The sphincter is yanked open by the motion of the larynx resulting from the upward and forward pull of the floor of the mouth muscles
• The leading edge of the bolus reaches the sphincter and the pressure within the bolus widens the opening
• The bolus passes through the sphincter
• The larynx lowers
• The cricopharyngeus muscle returns to same level of contraction

Question 23

tongue base and pharyngeal wall action

Answer 23

The tongue shape is ramp like and directs the bolus into the pharynx

The tongue base retraction and pharyngeal wall contraction occur when the bolus tail reaches the tongue base level.

When base of tongue and pharyngeal wall make contact, increased pressure occurs and the pharyngeal wall contractions continues down the pharynx to the UES

Question 24

pharyngeal transit time

Answer 24

Time it takes for the bolus to move from the point at which the pharyngeal swallow is triggered through the cricopharyngeal juncture into the esophagus – (1 second or less)

Question 25

epiglottis

Answer 25

Directs the material around the airway rather than over the airway

The two portions of the bolus join again at the level of the opening of the esophagus

Question 26

esophageal phase begins

Answer 26

Begins where the bolus enters the esophagus at the UES until it passes into the stomach at the LES

Question 27

esophageal transit time

Answer 27

Material is moved through peristalsis

Transit time can vary from 8 to 20 seconds

Question 28

difference between UES and LES

Answer 28

UES – musculoskeletal valve made up of the cricopharyngeus muscle and the cricoid muscle
- Opens to allow food to enter the esophagus

LES – muscular sphincter that allows food to enter the stomach
- Designed to keep food and stomach acid in the stomach and prevents reflux of material coming back from stomach into the esophagus