Swallowing Anaphysio Flashcards
What is mastication?
This is the process of preparing food for swallowing, also known as chewing;
Moving unchewed food onto the grinding surface of the teeth, chewing it, and mixing it with saliva
What is deglutition?
The processing of swallowing
This is the ball of food or liquid to be swallowed
Bolus
Moving unchewed food on the grinding surface of the teeth, chewing it and mixing it with saliva
Mastication
Why do we prepare the food for swallowing?
Answer: You chew to increase the food surface area –the food gets smaller but the surface area gets bigger (food surface area, meaning the area where the food is exposed to saliva or digestive enzymes). This aids in our digestion.
The act of chewing will trigger what?
The act of chewing will trigger the secretion of saliva and digestive enzymes–responsible for helping the breakdown of food in out stomach and intestine
When we say swallowing, how many phases are there?
3 but some include 4
What are the four phases of swallowing? (According to Seikel, et al.,)
Oral preparatory phase, oral stage, pharyngeal stage, esophageal stage
What are the three phases?
Oral phase, pharyngeal phase, esophageal phase
What is the oral preparatory stage?
The stage in which food is prepared for swallowing (mastication)
Stage of swallow in which the bolus is transmitted to the pharynx (propulsion of the bolus)
Oral stage
What is peristalsis?
The alternating contraction of the esophagus, responsible for propelling down the bolus to the esophagus to the stomach.
This is the roof of the mouth
Palate
Anterior part of the palate, and is known as a immobile bone. When we are chewing, the tongue rubs against this palate, thereby aiding the breakdown of the food.
Hard palate
This is the posterior part of the palate, and is a mobile muscle covered with mucous membrane. This keeps the nasal passages closed, elevating it which protects us from nasal regurgitation.
Soft palate
This is a pit “parang dimple” which is the origin of the thyroid gland. Marks the boundary between anterior ⅔ and posterior ⅓ of the tongue. This is where the thyroid gland originated from.
Foramen cecum
Taste buds are located at the palate. True or False.
True
The midline groove on our tongue or sulcus is called
Sulcus terminalis
What are faucial pillars?
Serve as boundary between oral cavity and pharynx
Difference between anterior pillars and posterior pillars
Anterior pillar are palatoglossal arches palato - palate, glossal - tongue, extend from soft palate to the sides of the tongue
Posterior pillars are palatopharyngeal arches, which extend from soft palate to the walls of the throat
Which mucous membrane builds up the anterior pillars?
Palatoglossus mucous membrane
Which mucous membrane counterparts the anterior pillars?
Palatopharyngeus mucous membrane
What is the eustachian tube?
This is an auditory tube also known as the pharyngotympanic tube which connects the middle ear to the back of the nose and throat (nasopharynx)
Equalizes pressure of the middle ear
It is a funnel-shaped conductive structure that is shared by the GIT and respiratory system
Ends at the level of C6 (where esophagus starts)
Pharynx
Describe the location of nasopharynx
Superior portion
Posterior to nasal cavity up to the uvula
Oropharynx
Middle chamber
Posterior to oral cavity
Also known as the hypopharynx. This is the inferior portion. Hyoid bone to lower margin of larynx
Laryngopharynx
This is the common passageway for food, air, and water
Oropharynx and laryngopharynx
Conditions inspired air
Nasopharynx
This is where you will see the Eustachian tube
Nasopharynx
This is where you see the tonsils
Oropharynx
This is what you call a spit trap or trap for the saliva to prevent saliva from triggering the swallow reflex when we sleep–Depressions to catch saliva and occasionally food to prevent the swallowing reflex
(Epiglottic) vallecula
This is a flap elastic cartilage located at the base of the tongue, which prevents food and liquids from entering the airway (trachea) during swallowing
Epiglottis
This is a false or superior vocal cords. It serves as a protective function.
Ventricular folds
This is a ring-shaped cartilage located in the lower part of the larynx. It maintains airway patency. Help support the structure so that the larynx won’t collapse.
Cricoid cartilage
It is a U-shaped bone located in the anterior midline of the neck and serves as attachments for different structures
Hyoid bone
Pyramid-shaped cartilage found in the larynx that is essential to the production of vocal sound. It plays a crucial role in closing the glottis
Arytenoid cartilage
What is the cavity size of an infant in comparison to an adult?
Infants have smaller oral and pharyngeal cavities, however, the oral cavity of infants takes a greater portion of the face in comparison to adults.
Difference of the size of the tongue of an infant and adult
Younger individuals occupy a larger portion of the oral cavity–higher tongue positioning in infants due to primitive sucking reflex, harder to manipulate food and bolus formation.
The larynx of an infant is more ________ in comparison to an adult
Anterior
High position of the larynx for infants located at the neck allows what?
Help compensate for the short airway, to prevent aspiration; it will accommodate shorter airways and aid with breathing when lying down.
Allows for nasopharyngeal channels for breathing during sucking–it helps in the sequential process of breathing while sucking.
The larynx descends during the _____________ years
First four years
The glottis of an infant is at
C3 - C4, while for the adult it is C5 - C6
Describe the epiglottis of a child
Infants have long, floppy, and narrow epiglottis, which predisposes to aspiration or airways obstruction
Describe the cricoid and trachea of an infant
Cricoid for an infant is the narrowest part of the child’s airways
Trachea is narrow and less rigid in children.
The velum is proportionally _______ in infants
Larger
Hyoid bone is more ________ and forward for infants
Elevated
True or False. Presence/absence of mature teeth impacts chewing and formation of bolus.
True
What are the immature swallowing patterns of an infant?
Sucking reflex
Rooting reflex
What is the rooting reflex? It persists until?
Lightly stroking the lips or cheek on one side causes the infant’s mouth to open with tongue thrusting and its head to turn toward the stimulus
Persistence of this reflex is 4-6 months
What stimulus is used to trigger the sucking reflex?
Tactile stimulation of the roof of the mouth.
What is the response of the child when there is tactile stimulation of the roof of the mouth?
Purse lips and tongue protrusion
What stimulus is used to trigger the rooting reflex?
Tactile stimulation of infant’s mouth/perioral space
Describe the tongue-thrust swallow
After four or five thrusts of the tongue, a swallow is triggered. The tongue base lowered to permit the milk bolus to enter the oropharynx during the next forward pumping action of the tongue.
Difference between the suckling pattern and sucking pattern? What age do they transition?
Suckling pattern is a front-to-back movement. Suckling’s function is to release the milk out of the breast (forward-backward movement). Around 3 months of age, the suckling pattern matures into a sucking pattern. The sucking pattern is the straight up-and-down movement of the tongue and jaw; this shows greater control in terms of the jaw and tongue of the infant, and it also prepares the infant to take in other food consistencies.
Features of infantile swallow
Jaws are apart with tongue placed between the gum pads
Mandible is positioned by muscles of facial expression
Swallow is guided by lips and tongue
Typical characteristics of a sucking and swallowing
Cheeks caving in
Bobbing hyoid bone
Tongue elongation
Head extension
Anterior mandibular thrust
Pursed lips (around the nipple)
CBT HAP
What are the key differences between immature and mature swallowing?
- The mature swallow requires the contraction of mandibular muscles (present in adults, absent in infants), to counteract the force of the tongue.
- While for immature swallow, contraction of mandibular muscles is not needed; what is critical for immature swallowing is the maxillary dental arches and proper development of hard palate.
What are the stages of mastication and deglutition?
Oral preparatory phase (mastication)
Oral stage (bolus propulsion)
Pharyngeal stage
Esophageal stage
This is the oral transport, when the tongue propels the bolus backwards, or bolus propulsion. What stage is this?
Oral stage
The bolus is at the pharynx
Pharyngeal stage
This is the stage where the food is prepared for swallowing. This is also the voluntary process but can be automatic
Oral preparatory stage
When does oral preparatory start?
It will start via sensory perception, when food is introduced to the mouth. If liquid, it is sealed within the oral cavity by lips (anterior) and hard palate (posterior)
The posterior portion of the tongue bunches up (elevated) and the soft palate is pulled down. This is to keep the food inside the oral cavity. What stage is this?
Oral preparatory stage
The food is kept inside the oral cavity because of these structures
Tongue and soft palate
This structure keeps the food in place and compress against hard palate
Tongue
What are the salivary glands?
Parotid
Submandibular
Sublingual
The grinded food mixes with saliva to lubricate the food, making it easier to swallow during the oral preparatory phase. True or false.
True
What facial muscles are active during the oral preparatory stage?
Orbicularis oris
Mentalis
Buccinator
Risorius
4 muscles
What mandibular muscles are active during the oral preparatory stage?
Masseter
Temporalis
Medial pterygoid (Internal pterygoid)
Lateral pterygoid (External pterygoid)
4 muscles
The function of these mandibular muscles during the oral preparatory stage is to elevate the mandible.
- Masseter - elevates mandible
- Temporalis - elevates mandible; retracts and protrudes mandible
- Medial pterygoid - Elevates mandible; moves mandible laterally; grinds mandible
What mandibular muscle protrudes and grinds the mandible (oral preparatory stage)?
Lateral pterygoid
What tongue muscles are active during the oral preparatory stage?
Mylohyoid, geniohyoid, digastric, superior longitudinal, inferior longitudinal, vertical, genioglossus, styloglossus, palatoglossus (9 tongue muscles)
To help you remember:
- Extrinsic muscles of the tongue: (Depressors of mandible: digastric, mylohyoid, geniohyoid; Tongue retractors: Styloglossus and genioglossus (anterior);
- Tongue elevator: Palatoglossus (the palatoglossus elevates the tongue and also depresses the velum) 6 MUSCLES
Intrinsic muscles of the tongue: Superior longitudinal, inferior longitudinal and vertical
What soft palate muscles are active during the oral preparatory stage?
Palaglossus and palatopharyngeus
What cranial nerve helps during the oral preparatory phase?
CN V, CN VII, CN XII, CN IX, CN X, CN XI (Pharyngeal plexus)
What is the function of the orbicularis oris?
Maintains oral seal
This muscle elevates lower lip
Mentalis
These muscles flatten cheeks (maintains cheek tension)
Buccinator and risorius
What is the function of the buccinator and risorius?
Buccal wall muscle is to tense the cheeks to avoid the food from entering the lateral sulcus (between the gums and cheek)
Occurs when bolus is ready to be swallowed. What stage is this?
Oral stage
Contact with faucial pillar, soft palate, or posterior tongue will trigger what?
Pharyngeal stage
Mandibular muscles responsible for oral stage. What innervates these muscles?
TIM (Temporalis, internal pterygoid (medial pterygoid), masseter). CN V
What are the tongue muscles responsible for the oral stage?
Mylohyoid, superior longitudinal, vertical, genioglossus, styloglossus, palatoglossus
This is the stage where respiration ceases
Pharyngeal stage
Respiration ceases reflexive due to:
Velum elevated
Tongue retracted
Lips sealed
Pharyngeal stage starts with the _______________
Elevation of the soft palate, separating oropharynx from nasopharynx
Pharyngeal swallow response happens when bolus reach? If older?
Faucial pillars
Posterior base of tongue near vallecula (older individual)
What happens to the oral and nasal outlets during the pharyngeal phase
- Oral and nasal outlets are closed (airways are sealed)
Food is entering the pharynx so airway must be protected via: vocal folds tightly adduct, constriction of the false vocal folds, and depression of epiglottis via aryepiglttic muscles and elevation of larynx relative to the tongue
What happens to the larynx and epiglottis during swallowing?
Larynx moves up and forward, while epiglottis descends assisted by the aryepiglottic muscles
The movement of pero-anterior of the larynx contributes to the esophagus in what way?
Gives more safe to the esophagus, which increases the chance for the food to enter the esophagus rather than the larynx
Explanation: As the larynx moves up and forward, this allows the esophagus to have more space preventing aspiration. The forward motion of the laryn also helps pyll the UES open, allowing the bolus to pass from the pharynx into the esophagus more easily.
Also known as the upper esophageal sphincter (UES)
Cricopharyngeus
During swallowing, this muscle is inhibited by the elevation of the larynx
Cricopharyngeus
The cricopharyngeus muscle remains tonically contracted to keep the upper esophageal closed. However, during the swallowing process, the muscle must be inihibted (it is relaxed) so that the UES can open to allow the bolus to pass from the pharynx into the esophagus.
What are the tongue muscles involved during the pharyngeal stage?
Mylohyoid, geniohyoid, stylohyoid, thyrohyoid, digastric, superior longitudinal, inferior longitudinal, vertical, genioglossus, styloglossus, palatoglossus, transverse, hyoglossus
What are the soft palate muscles during pharyngeal stage?
Levator veli palatini, tensor veli palatini, musculus uvulae
What are the pharyngeal muscles during the pharyngeal stage?
Palatopharyngeus (narrows pharynx; lowers soft palate), salpingopharyngeus (elevates lateral pharyngeal wall), stylopharyngeus (elevates and opens pharynx), cricopharyngeus, middle constrictor (narrows the diameter of the pharynx), inferior constrictor
This stage is purely reflexive and starts when bolus reaches the orifice of esophagus
Esophageal stage
Bolus is transported through esophagus until the LES through:
Peristaltic contraction and gravity
When bolus enters the UES, what happens after?
Cricopharyngeus will contract again
Larynx and soft palate depresses
Respiration resume
Pressure during oral preparation stage
Oral and pharyngeal pressure = atmospheric pressure due to open nasal airway
Kung saan mababa ang pressure doon pupunta ang bolus. True or False
t
Cricopharyngeus contracts most during
Inspiration
