Swallowing Flashcards
How many stages of swallowing are there?
4
Can you name the swallowing stages?
Oral Preparatory
Oral
Pharyngeal
Oesophageal
In the oral preparatory phase, what is the role of CN 5?
Lateral and rotatory chewing?
In the oral preparatory phase, what is the role of CN 12?
Motor innervation to the tongue to manipulate food to form a bolus
In the oral preparatory phase which muscles contract to decrease bolus entering lateral sulci?
Buccinators
In the oral preparatory phase, what is the role of CN 10?
Lowering of soft palate to prevent posterior leakage?
Which muscle, and therefore CN is responsible for preventing posterior leakage?
Vagus
Soft Palate (all muscles minus the TVP)
When is the oral stage initiated?
When tongue begins posterior bolus movement
What is the function of the negative pressure created by the buccinators in the oral phase?
Helps to move the bolus posteriorly
How long should the oral stage be?
No more than 1 second
When is a swallow triggered?
When the bolus reaches faucial arches - oral stage
When does the soft palate elevate?
In the oral stage, as the swallow is initiated.
Name the faucial arches?
Palatoglossal and palatopharyngeal arches.
Which pair of tonsils sit between the palatoglossal and palatopharyngeal arches?
Palatine
Which faucial arch is more posterior?
Palatopharyngeal
What is another term for the faucial arches?
The anterior and posterior arches of the palate
Is the oral stage voluntary?
Yes, up until point of swallow as it can be involuntary too.
The propulsion of the bolus through the pharynx usually takes what length of time?
Less than 1 second
What is the Pharyngeal stage?
The propulsion of the bolus through the pharynx
During the Pharyngeal stage, the palate elevates. What do the tongue and pharynx do?
Tongue base retracts
Pharynx constricts
What are the 3 levels of closure during the pharyngeal stage?
Epiglottis folding over the larynx
Vocal folds adduct
False vocal folds adduct
What are the 3 valves of the swallow?
Velopharyngeal
Laryngeal (closures of the pharyngeal stage)
Cricopharyngeal
What causes the Cricopharyngeal valve to open?
-Relaxation of the cricopharyngeal muscle
-Larynx moving upward and forward
-Bolus pressure on sphincter
What is the function of the valving system during the swallow?
Allows for different areas of pressure.
Positive around the bolus, negative below it.
Allows the bolus to move.
Which two structures have to move in order to create the negative pressure which sucks the bolus into the pharynx?
In which way do these structures move?
The pharynx + hyoid tilt and elevate
What is the normal breathing pattern during swallowing and what is the breathing pattern of the elderly?
Why does elderly swallow have an increased aspiration risk?
Normal = breathe in, breathe out slightly, stop swallow, then continue breathing out
Elderly = breathe out, breathe in slightly, stop swallow, then continue in
Elderly - breathing in after swallow means residue could be aspirated
How does the larynx change with age?
Drops up to half and inch - impacts laryngeal valve of epiglottic closure
Penetration vs Aspiration
*Penetration occurs when the bolus enters the
laryngeal vestibule but is not aspirated below the
level of the vocal folds
Along with intact sensation, what needs to be effective in order for a person to have an effective cough?
Effective glottic closure
To allow sublottic pressure to build
Which CN allows glottic closure?
Which muscle does this control?
Vagus
Recurrent Laryngeal Nerve
Interarytenoids - help to pull epiglottis downwards
There are 6 structural changes in the elderly swallow. How many can you name?
1) Increase in fatty and connective tissue in tongue and larynx
2) Reduced mastication strength
3) Reduced secretions bathing vocal folds and pharynx
3) Drop in larynx position
4) Increased likelihood of absent gag reflex
5) Longer transit time
Lower oesophageal sphincter not as effective in the elderly,
therefore increased risk of ___ important to note if the patient is NG/PEG fed.
Reflux
