stages & events of swallowing

Question 1

the stages of swallowing (3-4)

Answer 1

oral prepatory > oral (voluntary) > pharyngeal > esophageal

Question 2

oral prepatory stage (3)

Answer 2

mastication > bolus formation > bolus maintenance

Question 3

oral voluntary stage (5)

Answer 3

starts when tongue propels bolus posteriorly, tongue tip and sides move to alveolar ridge, soft palate elevates while tongue base drops, tongue pressure increases as viscosity increases, phase ends when bolus reaches ramus of the mandible

Question 4

how long it takes to complete the oral phase

Answer 4

1-1.5 seconds; .3 seconds longer for adults over 60 years

Question 5

pharyngeal phase (8)

Answer 5

velum elevates, BOT retracts, vocal folds ADDuct, pharyngeal constrictors contract sequentially, epiglottis retracts-inverts, laryngohyoid elevates and moves forward, laryngeal vestibule constricts, cricopharyngeus opens-relaxes

Question 6

how the pharyngeal phase is triggered

Answer 6

sensory input received from CN IX and X, tongue moves posteriorly, sensory info is decoded and swallow stimulus type is identified, information is sent out to trigger-initiate the motor response for the pharyngeal swallow

Question 7

cranial nerves of mastication (4)

Answer 7

CN V, VII, IX, XII

Question 8

cranial nerves of intraoral sensation (2)

Answer 8

CN V, IX

Question 9

cranial nerves of taste (2)

Answer 9

CN VII, IX

Question 10

cranial nerves of velar elevation (3)

Answer 10

CN V, X, XI

Question 11

pharyngeal transit (3)

Answer 11

bolus moves inferiorly via: gravity, BOT retraction, and pharyngeal wall contraction

(BOT retracts and contacts posterior pharyngeal wall, sequential contraction of the upper > middle > inferior constrictors)

Question 12

four mechanisms of airway protection

Answer 12

hyoid-laryngeal elevation away form the path of the bolus; epiglottic retroflexion; adduction of the true vocal cords; closure of the laryngeal vestibule or laryngeal additus

Question 13

epiglottic retroflexion (3)

Answer 13

hyoid moves anteriorly and tipping of the epiglottis into horizontal position occurs; BOT contributes to horizontal movement; larynx elevates to approximate hyoid so that epiglottis moves into vertical position

Question 14

cricopharyngeal opening-relaxation

Answer 14

**relaxation of the PE segment (upper esophageal sphincter) allows the bolus to enter the esophagus

elevation of larynx pulls UES open; duration increases as bolus volume increases

Question 15

reflexive cough (2)

Answer 15

motor and sensory involvement of CN X; it is a response to material entering deep into the laryngeal vestibule

Question 16

gag reflex (3)

Answer 16

motor involvement of CN X, sensory involvement of CN IX; triggered by noxious stimuli; designed to squeeze material out of the pharynx

Question 17

esophageal phase (2)

Answer 17

after bolus enters esophagus, food is carried to the stomach via gravity and esophageal peristalsis; esophagus joins the stomach through an opening in the diaphragm called the diaphragmatic or esophageal hiatus

Question 18

four doors of airway protection (4)

Answer 18

(1) closure of the TVFs; (2) closure of the FVFs; (3) arytenoid cartilages rocking forward; (4) epiglottis retroflexing