Pharyngeal Phase Flashcards
Is the pharyngeal phase voluntary or involuntary?
involuntary
What is more important during a swallow timing and speed of muscle movement or strength
timing and speed of muscle movement
T or F during swallowing, valves close off to prevent food from entering nose (velum contacts posterior pharyngeal constrictors) and airway (vocal cords close and larynx moves anteriorly)
True
in infants and older children’s were is sensory sent from to initiate the swallow?
It is sent from the upper pharynx and vallecular areas to brain (medulla)
Where is sensory info sent from to trigger a swallow in kids 5+?
it is sent from the back of mouth (primarily anterior faucial pillars) and opening to pharynx
T or F once the reflex is triggered to swallow it is involuntary
True
The base of tongue does what?
it retracts towards posterior pharynx to make contact with pharyngeal constrictors to squeeze the bolus down
T or F with muscles of the base of tongue—adequate strength, there is firm and tight contact with the posterior pharynx
True
What pharyngeal constrictors make up the lateral and posterior pharyngeal constrictors (3)?
superior
medial
inferior
What is pharyngeal stripping?
bolus stripping tongue to pharynx
the top-down squeeze of the pharyngeal constrictors and the base of tongue
posterior pharyngeal wall contracts to meet what structure during the pharyngeal swallow to squeeze the bolus down?
the base of tongue
T or F the hyoid bone in infants is already so high that there is not much hyolaryngeal elevation during the swallow.
True
during the swallow the hyoid bone moves anteriorly and elevates during activation of swallow
elevation starts to increase after 6 mos
during the swallow when the hyoid elevates and moves anteriorly what follows?
the larynx
what does hyolaryngeal excursion contribute to during the swallow?
it contributes to epiglottis retroflexion/inversion (flips down backwards)
After hyolaryngeal excursion and epiglottis inverts what else happens during the pharyngeal swallow?
the vocal folds adduct to close
the vocal folds stay closed until after swallow then a reflexive exhalation happens when they open
When do the vocal folds open after the pharyngeal swallow?
once the bolus passes through the UES
Once the bolus passes through the UES what happens with breathing?
there is a reflexive exhalation
In infants how is the epiglottis different?
It remains in contact with the velum during the oral phase for extra airway protection
For infants what does the epiglottis’s anatomical position aid in?
it aides in directing the bolus laterally to pyriform sinuses for swallow
(vs. medially towards the vocal folds)
What is the vallecular space/vallecula/valleculae
small reservoir forms at base of tongue and epiglottis
Is poling of food and liquid in the valleculae normal?
NO
Where do infants trigger their swallow at?
the valleculae
what is a pocket that is formed by fibers running from the thyroid cartilage to cricopharyngeal sphincter?
pyriform sinuses
Is pooling in the pyriforms normal?
NO
what is the UES or CP mad up partially of?
the inferior pharyngeal constrictor
The CP is partially opened by?
partially opened by the movement of the larynx pulling on the CP muscle and causing it to stretch and open therefore relax
T or F the esophagus and stomach begin bellow the CP
true
T or F the bolus travels down esophagus via peristalsis
true
LES is the porthole between what?
the esophagus and the stomach
what is the LES’s job?
to allow food into the stomach and it is what keeps food from refluxing back up into esophagus and pharynx
True or False.swallowing is a step by step process and things do not happen simultaneously.
False things happen simultaneously in a synchronized manner
what are the 9 steps of swallowing pharyngeal phase?
- bolus passes over the anterior faucial pillars and other posterior oral receptors and triggers the pharyngeal swallow (at vallecuale for infants)
- vf adduct and clos, closing off opening to trachea
- soft palate velum elevates to meet the posterior pharyngeal wall to close of nasal cavity
- base of tongue retracts to meet the posterior lateral pharyngeal constrictors to push the bolus downward via peristaltic wave motion (pharyngeal stripping)
- larynx moves anteriorly (minimal with infants) which causes the epiglottis to invert, partially covering the opening to the airway
- bolus passes through the pharynx
- bolus passes through cp sphincter initiating the esophageal phase of the swallow (esophagus uses peristaltic to propel the bolus down)
- all structures that are open and return to the resting position and breathing resumes after a reflexive exhalation
- there should be nothing coating the pharynx all materials of the bolus are gone.
do the 4 seals create positive pressure or negative?
positive
what are the 4 seals?
anterior seal
velopharyngeal
vocal fold closure
Cp
what makes up the anterior seal?
anterior tongue against the hard palate creates pos pressure
what 3 things cause the bolus to move downward?
- the 4 seals create positive pressure
- Negative pressure of the hyoid and larynx moving anteriorly and elevating
- muscle contraction of the pharyngeal constrictors and the base of tongue
what creates negative pressure during the pharyngeal phase to propel bolus down?
hyoid and larynx move anteriorly and elevate this creates a negative space which builds negative pressure and pulls the bolus in that downward direction where they were positioned at rest.
what muscles contract to propel the bolus downward during the pharyngeal swallow?
posterior pharyngeal constrictors and base of tongue contract and meet each other in a top-bottom peristaltic wave to push bolus down (the pushing pressure of the muscles also creates some pos pressure
In pedi anatomy where is the larynx located compared to adults?
in adults the larynx is located at the c5-c6
in pedis it is higher and is located at c2-c3
it sits close to the base of the epiglottis
True or false: the hyoid bone sits more anterior and higher as well
True
from birth to 6 mos the velum and epiglottis are in contact with each other at rest and during oral phase (secondary to epiglottis’s elevated position which causes infants to be what kind of breathers?
this causes infants to be obligate nose breathers
they cannot breath out of mouth
T or F. the epiglottis is shorter narrower softer and projects posteriorly at an 45 degree angel close to a horizontal position
True
T or F. The posterior wall moves further anteriorly in children to contact the base of tongue during swallow to push bolus downward
True
