Stage Prep : ch2. Normal swallowing in adults

Question 1

Discuss what happens in order for the bolus to flow from the mouth to the stomach.

Answer 1

The preparation and movement of a bolus during swallowing can be theoretically conceived as a series of valves that must open and close in a coordinated manner. This activity creates zones of high pressure around the bolus and zones of negative pressure below the level of the bolus. These pressure mismatches, together with gravity, create bolus flow.

Question 2

What are the 4 stages of swallowing?

Answer 2

(1) the oral preparatory stage, in which food is masticated in preparation for transfer;

(2) the oral stage, which entails the transfer of material from the mouth to the oropharynx;

(3) the pharyngeal stage, in which material is transported away from the oropharynx, around an occluded laryngeal vestibule, and through a relaxed cricopharyngeus muscle into the upper esophagus; and

(4) the esophageal stage, in which material is transported through the esophagus into the gastric cardia.

Question 3

How is the respiratory system protected when you swallow?

Answer 3

By occlusive (stopping the flow of air) muscular constriction of the laryngeal vestibule and downward displacement of the epiglottis.

Question 4

What are the valleculae?

Answer 4

The valleculae are lateral recesses at the base of the tongue on each side of the epiglottis.

Question 5

What are the piriform sinuses?

Answer 5

The piriform sinuses are lateral recesses between the larynx and the anterior hypopharyngeal wall

Question 6

Why is it important to know where the valleculae and the piriform sinuses are located?

Answer 6

These recesses serve as important anatomic landmarks in the videoradiographic assessment of pharyngeal swallow.

Question 7

Which cranial nerve innervates the principal muscles for chewing?

Answer 7

The mandibular branch of the trigeminal nerve (cranial nerve [CN] V)

Question 8

Name the 3 primary muscles of chewing.

Answer 8

1. masseter : closes the jaw
2. temporalis : moves the jaw up, forward, or backward
3. pterygoid : grinding food

Question 9

Which 6 cranial nerves are good to know when working in dysphagia?

Answer 9

CN VII Facial nerve (controls lip, mouth, chin)

CN XII Hypoglossal (controls tongue)

Vagus raises soft palate)

Accesory nerve

Glossopharyngeal nerve

Trigemional nerve (controls jaw)

Question 10

Normal swallowing performance depends on the rapid transfer of the bolus from the oral cavity to the stomach. A liquid bolus may pass through the pharynx within _____seconds and enter the stomach in less than_____ seconds.

Answer 10

A liquid bolus may pass through the pharynx within 2 seconds and enter the stomach in less than 5 seconds.

Question 11

During the oral phase, why is laryngeal elevation important ?

Answer 11

Rapid and complete laryngeal elevation (2 to 3 cm on average) aids in creating negative pressure in the region of the hypopharynx.

Question 12

What is the relationship between breathing and swallowing (3 points)?

Answer 12

1. anatomy (common conduits of mouth and pharynx)
2. both controlled by the medulla of the brainstem
3. disorders of respiration often affect swallow safety

Question 13

When you are eating, at what point do you stop breathing?

Answer 13

Before the onset of the oral stage of swallow

Apnea does not occur until the bolus collects at the vallecular level.

Question 14

Describe the breathing pattern when you are swallowing

Answer 14

exhalation-swallow-exhalation

Question 15

How long does swallow apnea last?

Answer 15

from 0.75 to 1.25 seconds depending on the subject’s age and bolus size.

In general, the larger the bolus size, the longer the duration of swallow apnea.

Question 16

Once the bolus is prepared, the tongue tip is elevated to occlude the anterior oral cavity at the alveolar ridge, and the bolus is held against the hard palate. Which stage is this?

Answer 16

Oral stage

Question 17

How do you know when the pharyngeal stage begins and ends?

Answer 17

The pharyngeal stage begins when the bolus arrives at the level of the valleculae and ends when the PES closes. Ninja Nerd says it begins when the bolus touches the palatoglossal arch…

Question 18

What is the esophagus?

Answer 18

The esophagus is a distensible tube, approximately 21 to 27 cm (10 inches) long, connecting the pharynx (at C6) and stomach (at T12). It is separated from the pharynx by the pharyngeal esophageal segment (PES) and from the stomach by the lower esophageal sphincter (LES).

Question 19

Is the esophgeal lumen open or closed before the bolus enters the esophagus? Identify the esophageal lumen on a diagram.

Answer 19

Before the bolus enters the esophagus, the esophageal lumen remains closed within the chest cavity under negative pressure.

Question 20

How and why do you stop breathing when you swallow?

Answer 20

Protection of the airway to achieve a safe swallow is multifaceted. It is accomplished by primary airway closure at the level of the true and false vocal folds, laryngeal elevation, tongue base retraction, and epiglottic tilt.

Question 21

What would have a greater impact modifying texture or modifying volume of the food / liquid being consumed?

Answer 21

In general, researchers agree that swallow-generated pressures are more sensitive to changes in viscosity than are changes in volumes of the same consistency.

Question 22

Name 2 pre-requisites for drinking with a straw

Answer 22

1. adequate lip strength
2. capacity to generate intraoral pressures to draw the fluid into the oral cavity

Question 23

SI LA PERSONNE A UNE ATTEINTE AU TRONC CÉRÉBRALE, ça veut dire quoi

Answer 23

Il aura des problèmes de déglutition. Le swallow center est le tronc cérébrale.