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Dysphagia > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What are the stages of a swallow?

A

Oral preparatory stage (chewing)

Oral stage (propulsion of bolus)

Pharyngeal stage (pharyngeal swallow)

Esophageal stage (esophageal transit)

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2
Q

The swallow is not _____

A

segmental, what takes place in one phase will affect the others

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3
Q

What are the two binary goals?

A

Seal the airway

Move food through to the esophagus

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4
Q

What are major events in the oral prep phase?

A

Sealing oral cavity (close lips, posterior tongue to velum)

Mastication of bolus (if needed)

Mixing bolus with saliva (starts digestion)

Dividing bolus into pieces for transport to pharynx (piecemeal deglutition)

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5
Q

What nerves and muscles are used in the oral prep phase?

A

Obicularis oris (CN VII) - lip opening and closing, lip seal

Buccinator (CN VII) - contracts to keep bolus on teeth/prevent pocketing in cheeks

Tongue sensation (taste and touch, CN V, VII, IX) - to determine taste, size, texture and location of bolus

Tongue muscles - alter shape and tone of tongue during oral prep to move bolus (CN XII) AND elevate posterior tongue to seal with velum (contraction of palatoglossus, CN X)

Muscles of mastication (CN X) - contract and relax to facilitate chewing. Break down bolus and mix with saliva

Salivation (CN VII, IX) - lubricate and early digestion of bolus (mandibular sinus)

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6
Q

Why is saliva very important?

A

Maintains healthy oral tissue

Prevents tooth decay

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7
Q

How much saliva does an average healthy person produce daily?

A

1-1.5 Liters

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8
Q

What is not a sign of impairment in the oral prep phase?

A

Oral seal not being constant during mastication

Chewed bolus collecting in vallecula as other food is being chewed

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9
Q

What are major events in the oral phase?

A

Bolus is propelled from oral cavity to pharynx

Soft palate elevation

Voluntary opening of the pharynx (velum lifts with posterior tongue depresses)

Early hyoid elevation (in anticipation of pharyngeal phase)

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10
Q

What nerves and muscles are used in the oral phase?

A

Superior longitudinal muscle (CN XII) - tongue tip elevation to alveolar ridge

Levator veli palatini (CN X) - elevation of velum

Hyoglossus & styloglossus (CN XII) - posterior tongue depression

Anterior tongue (CN XII) - compression against hard palate in anterior to posterior wave to move bolus along dorsum of tongue

Obicularis oris & buccinator (CN VII) - contract to present pressure escape at lips )

Superior pharyngeal constrictor (CN X) - contracts to close around elevated velum (protection against nasal regurgitation)

Mylohyoid (CN V) - moderate hyoid elevation in prep of pharyngeal phase

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11
Q

Swallowing occurs during _____

A

apnea or cessation of breathing

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12
Q

You should not ______ after swallow

A

inhale

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13
Q

What are the normal swallowing patterns

A

Exhale > Apnea/Swallow > Exhale ~ 80%

Inhale > Apnea/Swallow > Exhale ~ 20%

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14
Q

What are the characteristics of the pharyngeal phase?

A

COMPLEX - Pharynx goes from default breathing fashion to secondary swallowing fashion

FAST/EFFICIENT - Apnea can’t last long so swallow must be fast. < 1 sec in healthy swallows

EXCITATORY and INHIBITORY - Involves both activation and inhibition of muscles in a coordinated fashion

INVOLUNTARY - Can not stop or reverse event

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15
Q

What are major events in the pharyngeal phase?

A

Jaw stabilization

Bolus transfer to pharynx

Hyo-laryngeal elevation

Laryngeal vestibule closure (epiglottis to arytenoids)

True and false VF closure

Pharyngeal shortening and constriction

Upper esophageal sphincter opening

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16
Q

Which major pharyngeal phase events protect the airway?

A

Hyolaryngeal excursion
Epiglottis to arytenoid
True and false VF closure (bottom-up (true first then false))

17
Q

Which major pharyngeal phase events move bolus through esophagus?

A 
Hyolaryngeal excursion
Base of tongue propulsion
Pharyngeal constriction and shortening
Gravity
Cricopharyngeal relaxation
Negative suction
18
Q

What nerves and muscles are used in the pharyngeal phase?

A

Muscles of mastication (CN V) - stabilize jaw and tongue muscles

Tongue muscles (CN XII) - propel bolus posteriorly, tongue base retraction

Superior, middle and inferior pharyngeal constrictors (CN X) - propel bolus through sequential pharyngeal constrictors (peristalsis)

Palatopharyngeus (CN X), salpingopharyngeus (X), stylopharyngeus (IX) - shorten the pharynx to decrease distance for bolus travel

Suprahyoid muscles - pull hyoid and larynx superior and anteriorly (mainly mylohyoid (CN V) for superior movement/anterior movement mainly by geniohyoid (C1))

Laryngeal muscles (CN X) - activate laryngeal adductors

Cricopharyngeus (CN X) - tonic contraction to keep UES closed

19
Q

What contributes to SAFETY of the swallow?

A

Airway protection:

Hyolaryngeal excursion
True VF closure
False VF closure
Epiglottis to arytenoid seal

20
Q

What contributes to EFFICIENCY of the swallow?

A

UES opening (aka PES opening)

Tongue propulsion
Pharyngeal contraction and shortening
Hyolaryngeal traction forces
Gravity
Cricopharyngeal relaxation
Negative pressure
21
Q

What are major events in the esophageal phase?

A

Bolus is transported down esophagus to stomach

The lower esophageal sphincter (LES) relaxes and bolus moves into stomach

22
Q

What is the longest phase of swallowing?

A

Esophageal (8-20 seconds)

23
Q

What nerves or muscles are used in the esophageal phase?

A

Esophageal muscle (CN X) - peristaltic wave of contraction to pusch bolus to LES which relaxes to move bolus to stomach

24
Q

First ____ of esophagus is made of and controlled by?

Last _____ are made of and controlled by?

A

First 1/3 is striated muscle - controlled by nucleus ambiguus

Last 2/3 is smooth muscle and controls by ANS

25
Q

What are causes of dysphagia?

A 
Neurological
Structural (tumor, surgical, edema)
Head and neck cancer
Aging
Other (meds, psychogenic, respiratory compromise)
26
Q

Penetration

A

Bolus in laryngeal vestibule ABOVE VF

27
Q

Aspiration

A

Bolus BELOW VF

28
Q

What is the response to Penetration?

A

Swallow

if no swallow, likely will lead to aspiration

29
Q

What is the response to Aspiration?

A

Cough

if not cough, silent aspiration

30
Q

What are two common places of bolus collection?

A

Vallecula

Pyriform sinus

31
Q

What may happen if a pt has no safety issues, just efficiency issues?

A

Weight loss
Social aspect/different diet
QOL implications

Dysphagia (13 decks)

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