Physiology of normal swallow

Question 1

function of oral preparation phase

Answer 1

• mastication
• bolus formation
• bolus maintenance

Question 2

voluntary control of oral prep phase

Answer 2

• Close lips, good buccal tension
• Velum lowered for nasal breathing
• Mastication
  * Lateral/rotary chewing action
  * Tongue elevates and pushes bolus posteriorly along the hard palate

Question 3

describe oral transport phase (when it begins and ends)

Answer 3

• Starts when tongue begins to propel the bolus
posteriorly
• Tongue tip and sides to the alveolar ridge
• Velum elevates, tongue base drops
• Oral phase ends when bolus reaches ramus of
mandible

Question 4

when is the pharyngeal phase triggered? (where)

Answer 4

sometime between the ant. faucial arches to the line of the ramus of the mandible.
• Anterior faucial pillar is trigger point in adult patients
• Middle of tongue base is trigger point in older
• Valleculae is trigger point in some normal infant

Question 5

Triggering the pharyngeal phase, delay?

Answer 5

• Voluntary, rapid, no delay (1 – 1.5 sec.)
• Abnormal if oral transport + delay > 2 seconds
• Persons over 60 yrs may 0.3 seconds longer

Question 6

How is the pharyngeal phase triggered?

Answer 6

• Sensory input from the oral cavity, tonsils, soft
palate, and post pharyngeal wall (CN IX & X)
• Posterior tongue movement
-hypothesized that sensory rec center in lower brainstem decodes info, identifies swallow stimulus, sends to nucleus ambiguous, initiate motor response for pharyngeal swallow

Question 7

describe pharyngeal phase

Answer 7

-involuntary
• Velum elevates (VP closure)
• Hyoid bone and larynx elevate and move anteriorly
• Airway closure at 3 levels (respiration apnea/stops)
• Tongue base contacts posterior pharyngeal wall
• Pharyngeal contraction
• Upper esophageal sphincter (UES) opens

Question 8

3 levels of airway closure (pharyngeal phase)

Answer 8

• Epiglottis
  * Epiglottic inversion also diverts bolus toward esophagus
• Aryeipiglottic folds & Ventricular folds (false vfs)
• True vocal folds

Question 9

bolus moves through pharyngeal phase via

Answer 9

• gravity
• base of tongue retraction
• pharyngeal wall contraction

Question 10

How long is esophageal phase in adult and children?

Answer 10

adult- 8-20 sec

chill- 3-10 sec

Question 11

What pulls UES open

Answer 11

elevation of larynx

Question 12

Peristalsis

Answer 12

wave like muscular reflexes, contract behind, relax in front

Question 13

Food is carried from esophagus to stomach via

Answer 13

gravity and esophageal peristalsis

Question 14

4 mechanisms of airway protection

Answer 14

1. hyoid/larynx elevation
2. epiglottis retroflection
3. laryngeal vestibule closure
4. true/false vf closure

Question 15

Reflexive cough is cranial nerve…. and motor or sensory

Answer 15

x, both

Question 16

gag reflex

Answer 16

CN IX sensory and X motor, squeeze material out of pharynx