Phases of swallowing Flashcards
Identify and briefly describe the 4 phases of swallowing
- Oral preparatory phase- lips contain bolus in mouth, food is manipulated in the mouth and masticated if necessary, reducing it to a consistency ready for swallowing
- Oral phase- tongue propels food posterior until the pharyngeal swallow is triggered
- Pharyngeal phase- bolus is moved through the pharynx
- Esophageal phase- esophageal peristalsis carried the bolus through the cervical and thoracic esophagus down into the stomach
The duration and characteristic of each swallow phase is dependent on?
The type and volume of food being swallowed
Swallowing and respiration have reciprocal functions…. what does this mean
Respiration halts during the pharyngeal phase of swallowing
List the 11 components of swallowing
- Lip closure
- tongue control/bolus hold
- Bolus prep/mastication
- bolus transport
- initiation of pharyngeal swallow
- soft palate elevation
- hyolaryngeal elevation (Laryngeal elevation + anterior hyoid excursion)
- laryngeal closure (epiglottis closure +laryngeal vestibular closure + pharyngeal stripping wave + pharyngeal contraction +tongue base retraction)
- Upper esophageal sphincter opening
- esophageal clearance
- lower esophageal relaxation
When is the oral phase of swallowing termination?
When the bolus head passes any point between the anterior faucial pillars and where the mandible crossess the tongue base
What organs are involved in laryngeal closure
-epiglottis (aryepiglottic folds)
-False vocal folds
-True vocal folds
What are the contraction patterns during esophageal clearance
- primary peristalsis (transit)- swallow initiated
- Secondary peristalsis- esophageal body
- Tertiary contractions- simultaneous non-productive
What three factors affect esophageal clearance
-number of swallows
-effects of bolus volume
-effects of bolus temperature
2 major components contributing to lower esophageal segment sphincteric pressure
-muscle tone
-diaphragm
Sensation in what 4 areas if important for swallowing
- tongue
- larynx (supraglottic space + subglottic space)
- pharynx (constrictors, upper esophageal sphincter)
- esophagus
What is the role of sensory feedback in mastication
- Monitor the progress of chewing and modify commands
- Monitor food hardness
What monitors the progress of chewing and modifies commands
receptor system in dentures, tongue, cheeks, jaw elevator muscles, temporomandibular joint
What is one of the major inputs into central pattern generator (CPG) where motor taste of mastication is controlled
food hardness
2 major sensory modulations in swallowing
- sensory feedback in mastication2. integration of chemical senses
What is meant by integration of chemical senses?
Flavor perception gathered through smell and taste
Explain the two components of flavor perception
Integration of chemical sense 1. smell & 2. taste
- smell identifies, detects the concentration, and the quality of the odorant chemical stimuli
- taste provide information on identity (sweet, sour, salty, etc.), temperature, texture, and location
Explain taste reception
taste involves conjunction of olfactory and trigeminal chemoreceptive systems to provide information on identity (sweet, sour, salty, etc.), temperature, texture, and location
explain smell reception
smell involves sensory receptors in the olfactory epithelium that detect the identify, concentration, and quality of the odorant chemical stimuli
3 types of stimuli seen in sensory modification
- chemical stimuli
- thermal stimuli
- tactile stimuli
What are chemical stimuli
saliva stimulation
water
citric acid
sour bolus
What is thermal stimuli
Hot vs cold
What is tactile stimuli
Touch and pressure:
-Larger bolus
-Viscosity
-air puff stimulation
Four main functional aspects of dysphagia
- bolus transit
-airway protection
-pump failure
-sensation
What structures make up the anterior and posterior seal of the oral cavity during oral preparatory and oral phase
Anterior seal: lips
Posterior seal: velum/soft palate and back of tongue make contact
What is the purpose of the posterior seal of the oral cavity
The tongue and soft palate seal to prevent early spillage into the pharynx
What is soft palate elevation & what is the purpose
The soft palate elevates making contact with the posterior pharyngeal wall
Purpose: prevent bolus from entering into the nasal cavity
Role of the tongue during the oral phase of swallowing
The tongue tip elevates, making contact with the hard palate, while cupping the sides to contain the bolus
Then the tongue pushes against the hard palate, creating pressure against the bolus tail, to propel the bolus through the oral cavity towards the pharynx
When there is penetration or aspiration, what are 4 important factors we want to evaluate?
- Anatomical changes: presence, absence, or disturbance in swallowing organs
- Timing: does penetration/aspiration occur before, during, or after swallow
- Severity: less than or greater than 10% bolus aspirated & constancy of penetration/aspiration
- Patient response and efficacy: presence/absence of cough; degree of material clearance
Strategies/Compensations used if swallow safety is impaired (penetration or aspiration)
- head turn
- supraglottic swallow manueuver
- super-suprasubglottic swallow manueuver
- Chin tuck
- Dry swallow
- volume and/or viscosity modification
List the 3 types of penetration
- flash
- trace
- deep
If there is a problem with efficiency, causing residue, what are we evaluating?
- Residue location (oral cavity, tongue base, posterior pharyngeal wall, vallecula, pyriform sinuses, laryngeal vestibule)
- Amount/percentage of residue (trace, mild, moderate, significant)
- Patient response (sensation eliminated or reduced & clearance ability eliminated or reduced)
Strategies/Compensations used if swallow efficiency is impaired (residue)
- dry swallow
- effortful swallow
- liquid wash
- head turn
- Modify texture, consistency, and/or flavor
Approximate duration of a normal swallow?
2 seconds or less
The muscles of chewing interact with how many pairs of pharyngeal and laryngeal muscles?
26 pairs
What type of variations in bolus are accommodated for in normal swallowing
Variations in bolus size, texture, and temperature
In the oral preparatory phase of swallowing what 3 things happen?
- teeth, lips, tongue, cheeks, mandible, and palate grind and manipulate the food
- food is mixed with saliva
- formation of a bolus consistency appropriate for safe swallow
Approximately how long is the oral phase, pharyngeal phase, and esophageal phase of swallowing?
Oral phase- 1 second
Pharyngeal phase- 1 second
Esophageal phase- 3 to 4 seconds
In the oral phase, what 6 things happen?
- lips and cheeks contract
- tongue presses the food against the hard palate
- food bolus is moved backwards by the tongue
- a central groove is formed in the tongue as a passage for the bolus
- bolus is moved to the anterior and posterior faucial (tonsillar) pillars, initiating the pharynegal phase of swallowing
- the soft palate moves superior and posterior to close off the nasopharynx
In the pharyngeal phase, what 8 things happen?
- Soft palate elevation
- Pharyngeal tongue propels the food posteriorly
- Closure of the larynx to the level of the true and false vocal folds
- retroversion of the epiglottis over the laryngeal vestibule
- Closure of the laryngeal vestibule
- elevation of the larynx under the tongue base
- contraction of the pharyngeal constrictors
- relaxation of the cricopharyngeal muscles
- opening of the cricopharyngeal sphincter by upward and forward motion of the larynx
What event happens during the esophageal phase?
Peristaltic contractions of musculature resulting in bolus movement into the stomach
