Juliet Reyes-
Who initially performed swallowing evaluation and provided swallowing treatment?
Occupational Therapists
-
Why did the responsibility for swallowing evaluation and treatment shift to SLPs?
SLPs had a greater understanding of the anatomy and physiology of the aerodigestive tract by virtue of their study of speech, language, and voice disorders.
-
What is Deglutition?
act of swallowing
-
What is Dysphagia?
difficulty moving food from the mouth to the stomach; expansion: to include behavioral, sensory, preliminary motor acts to prepare for the swallow
-
What are the anatomical structures used for swallowing?
Oral Cavity
Pharynx
Larynx
Esophagus – final stage
-
What makes up the oral cavity?
- Lips – external border
- Teeth
- Hard Palate/Maxilla
- Soft Palate/Velum
- Uvula
- Mandible
- Floor of Mouth
- Tongue
- FaucialArches
- Palatine Tonsils-between the anterior and posterior faucial arches
- Spaces between mandible and cheeks
- Spaces between maxilla and cheeks
-
What is the oral part of the tongue composed of?
body, divided by median sulcus
-tip/apex
*ends at circumvallate papillae (bumps at the back of the tongue)
-
What muscles make up the floor of the mouth?
Mylohyoid, geniohyoid, anterior belly of digastric
-
Where do the muscles of the floor of the mouth attach?
Mandible anteriorly and body of the hyoid bone posteriorly
-
Where is the base of the tongue located?
Pharynx
-
The base of the tongue extends from __________ to the ___________.
Circumvallate papillae, hyoid bone
-
What bone forms the foundation of the tongue?
Hyoid bone
-
How is the hyoid bone embedded in the soft tissue?
It is embedded in the base of the tongue
-
What is the articulation of the hyoid bone with other bones?
It does not articulate with any other bone
-
How is the larynx connected to the hyoid bone?
By the thyrohyoid ligament and thyrohyoid muscle
-
What happens to the larynx when the hyoid bone moves up and forward?
The larynx moves up and forward
-
What are the three pharyngeal constrictors?
Superior, medial, inferior
-
What do the pharyngeal constrictors form?
Posterior and lateral pharyngeal walls
-
What are the pharyngeal recesses?
Valleculae
Pyriform sinuses
-
What is the shape of the valleculae?
Wedge-shaped
-
What subdivides the valleculae into smaller spaces?
Hyoepiglottic ligament
-
Where are the lingual tonsils located in relation to the valleculae?
Rest against the base of the tongue (BOT)
-
What structures form spaces between the fibers of the inferior constrictor and the thyroid cartilage?
Pyriform sinuses
-
Where do the pyriform sinuses end inferiorly?
At the cricopharyngeal muscle
-
Where do the fibers of the cricopharyngeal muscle attach?
posterolateral surface of cricoid lamina
-
What is the function of the cricopharyngeal muscle at rest?
Prevents air from entering the esophagus during respiration
-
What structures form the valve into the esophagus?
Cricoid lamina and cricopharyngeal muscle fibers
-
What is the function of the cricopharyngeal region?
Reduces backflow of material from esophagus into the pharynx
-
What is the function of the upper esophageal sphincter (UES)?
To control the passage of food and liquids into the esophagus
-
When does the UES open?
During swallowing, to allow the bolus to pass into the esophagus
-
What are the two types of muscle layers found in the esophagus?
Inner circular and outer longitudinal
-
Which portion of the esophagus is composed of striated muscle?
Upper third
-
Which portion of the esophagus is composed of smooth muscle?
Lower third
-
Where does the esophagus sit in relation to the trachea?
Behind the trachea
-
What is the boundary between the esophagus and the stomach called?
LES (Lower Esophageal Sphincter)
-
Which structure separates the chest from the abdomen and is traversed by the esophagus?
Diaphragm
-
What structures form the boundaries of the laryngeal vestibule(opening to larynx)?
Epiglottis, aryepiglottic folds, arytenoid cartilage, ends of superior surface of false vocal cords
-
Where does the epiglottis rest?
Against the base of tongue
-
What is the epiglottis attached to?
hyoid bone by hyoepiglottic ligament
-
What is the base of epiglottis attached by?
ligament to thyroid notch
-
What structures form the lateral walls of the laryngeal vestibule?
Aryepiglottic muscle, quadrangular membrane, cuneiform cartilages
-
What is the role of the arytenoid cartilages?
To control the movement of the vocal folds
-
What is the anatomical relationship between the arytenoid cartilages and the cricoid cartilage?
The arytenoid cartilages are located at the rim of the cricoid cartilage posteriorly
-
What happens to the arytenoid cartilages during swallowing?
They tilt slightly, contributing to airway closure
-
What muscles are involved in the composition of the true vocal folds?
Vocalis muscle, thyroarytenoid muscle
-
Where are the false vocal folds located in relation to the true vocal folds?
Above and parallel to the true vocal folds
-
What is the space between the false and true vocal folds called?
Laryngeal ventricle
-
What is the role of the true vocal folds in the airway?
To serve as the last level of airway protection before entering the trachea
-
what are the sphincters of the larynx?
-Epiglottis and aryepiglottic folds
-Arytenoids
-Base of epiglottis
-False vocal cords
-True vocal cords
-
How can abnormalities of the cervical spine impact swallowing function?
Abnormalities of the cervical spine can affect swallowing function by narrowing the pharynx and potentially directing the bolus into the airway.
-
What are cervical osteophytes?
Cervical osteophytes are bony outgrowths that can develop from the cervical vertebrae.
-
What is a reflexive swallow?
The reflexive swallow is a brainstem event with cortical influence.
-
What is the role of afferent and efferent pathways in the swallow process?
The swallow is a motor movement (efferent) and sensory (afferent) process.
-
Where is the swallow center located?
The swallow center is located in the nucleus tractus solitarius in the medulla.
-
What triggers the brain on what to do with the bolus during swallowing?
Afferent signals from sensory receptors "feel" the bolus and trigger the brain on how to process it.
-
what are the phases of swallowing?
- Oral Preparatory Phase
- Oral Phase
- Pharyngeal Phase
- Esophageal Phase
-
What is the oral prepatory phase of swallowing?
The oral prepatory phase is a voluntary process where food is prepared for swallowing.
-
How is food kept in the oral cavity during the oral prepatory phase?
Food is kept in the oral cavity by maintaining a tight oral seal with the lips (orbicularis oris), which forces us to perform nasal breathing.
-
What muscles are involved in keeping the food in the oral cavity during the oral prepatory phase?
The tongue bunches up in the back, and the soft palate pulls down to keep the food in the oral cavity via the palatoglossus muscle.
-
Is the oral prepatory phase a voluntary or involuntary process?
The oral prepatory phase is a voluntary process where food is intentionally prepared for swallowing.
-
How does the palatoglossus muscle contribute to keeping the food in the oral cavity?
The palatoglossus muscle pulls the soft palate down, helping to prevent food from entering the pharynx prematurely.
-
What happens to the food during the oral prepatory phase?
The tongue moves the food onto the grinding surface of the teeth, pulling it back into the oral cavity to mix with saliva.
-
How does the tongue contribute to the oral prepatory phase?
The tongue moves the food back up for more mastication and helps in mixing the food with saliva.
-
What muscles are involved in keeping the food out of the lateral sulcus during the oral prepatory phase?
The muscles of the buccal wall, such as the risorius and buccinator, contract to keep the food from entering the lateral sulcus.
-
Is the oral phase of swallowing voluntary or involuntary?
The oral phase of swallowing is voluntary.
-
What happens to the tongue during the oral phase?
The tongue drops down and pulls posteriorly, and then the anterior part of the tongue elevates to the hard palate and squeezes the bolus back towards the faucial arches.
-
What triggers the pharyngeal stage of swallowing?
Once the bolus makes contact with the fauces (back of the throat), it triggers the pharyngeal stage of swallowing.
-
Describe the sequence of events during the oral phase of swallowing.
First, the tongue drops down and pulls posteriorly. Then, mastication (chewing) stops, and the anterior part of the tongue elevates to the hard palate and squeezes the bolus back towards the faucial arches.
-
Is the pharyngeal phase of swallowing voluntary or involuntary?
The pharyngeal phase of swallowing is involuntary.
-
What happens to the soft palate during the pharyngeal phase?
The soft palate elevates to close off the oropharynx from the nasopharynx.
-
What happens to respiration during the pharyngeal phase?
Respiration ceases during the pharyngeal phase to protect the airway as food enters the pharynx.
-
What role does the closure of the oral and nasal cavities play in the pharyngeal phase?
The closure of the oral and nasal cavities prevents air from escaping or entering during the pharyngeal phase, allowing the food bolus to be directed towards the esophagus.
-
How is the pharyngeal phase of swallowing controlled?
The pharyngeal phase is reflexively controlled, meaning it is automatically and involuntarily regulated by neural pathways and reflexes in the brainstem.
-
What happens to the vocal folds during the pharyngeal phase?
The vocal folds tightly adduct (close) during the pharyngeal phase to prevent food or liquid from entering the larynx.
-
What role does the epiglottis play in the pharyngeal phase?
The epiglottis drops down to cover the laryngeal aditus (entrance to the larynx) during the pharyngeal phase, preventing food or liquid from entering the airway.
-
How does the larynx move during the pharyngeal phase?
The larynx moves up and forward as a unit during the pharyngeal phase of swallowing.
-
Which muscles are involved in the constriction of the false vocal folds/epiglottis and the movement of the larynx during the pharyngeal phase?
The aryepiglottic muscles are responsible for constricting the false vocal folds and epiglottis, while other muscles coordinate the movement of the larynx during swallowing.
-
What happens to the cricopharyngeus muscle during the pharyngeal phase?
The cricopharyngeus muscle relaxes during the pharyngeal phase to allow the passage of food from the pharynx to the esophagus.
-
What propels the food down the pharynx during the pharyngeal phase?
Contraction of the pharyngeal constrictor muscles propels the food down the pharynx during the pharyngeal phase of swallowing.
-
How does the bolus pass over the epiglottis during the pharyngeal phase?
After approximately 1 second of pharyngeal transit, the bolus reaches the laryngopharynx and passes over the epiglottis.
-
What is the role of the pharyngeal constrictor muscles in the pharyngeal phase?
The pharyngeal constrictor muscles contract to propel the food bolus down the pharynx during the pharyngeal phase of swallowing.
-
What happens to the bolus during the pharyngeal phase?
The bolus divides into two equal masses on either side of the larynx and passes through the pyriform sinuses before recombining at the entrance to the esophagus.
-
What happens during the esophageal phase of swallowing?
The esophageal phase begins when the bolus reaches the orifice of the esophagus and involves the movement of the bolus through the esophagus via peristaltic contractions and gravity.
-
How does the bolus move through the esophagus during the esophageal phase?
The bolus moves through the esophagus during the esophageal phase via peristaltic contractions
-
Which muscle contracts during the esophageal phase to allow the bolus to enter the esophagus?
The cricopharyngeus muscle contracts to open the upper esophageal sphincter and allow the bolus to enter the esophagus. It relaxes again once the bolus has passed through.
-
What happens to the larynx and soft palate during the esophageal phase of swallowing?
During the esophageal phase, the larynx and soft palate depress, meaning they return to their resting positions after their upward movement during the pharyngeal phase.
-
Why do the larynx and soft palate depress during the esophageal phase?
The depression of the larynx and soft palate allows for the resumption of respiration. By returning to their resting positions, the airway is reopened, and breathing can resume.
-
What are the functions of saliva in swallowing?
Saliva lubricates the oral cavity, pharynx, and esophagus, making it easier for food to pass through these structures. It also assists in the digestion of starches and fats, breaking them down into smaller molecules. Additionally, saliva helps maintain low levels of acid in the esophagus, reducing the risk of acid reflux. It delivers proteins that help maintain the mucosal integrity of the esophagus and stomach, promoting a healthy digestive system.
-
What changes happen in the thyroid and cricoid cartilages and hyoid bone with age?
With age, the thyroid and cricoid cartilages, as well as the hyoid bone, undergo ossification. This means that these structures become more rigid and calcified. During fluoroscopy, these changes may be more prominent and visible.
-
What happens to the position of the larynx in older individuals?
In individuals over the age of 70, the larynx may lower in the neck. This is a natural change that occurs with age and can be observed during imaging or examination.
-
How does cervical arthritis affect the laryngeal area?
Cervical arthritis refers to the degenerative changes that occur in the cervical spine. These changes can affect the mobility and alignment of the vertebrae, which in turn can impact the position and movement of the laryngeal structures. Cervical arthritis may contribute to changes in swallowing and voice production.
-
How does the swallowing pattern change in older individuals?
In individuals over the age of 60, it is common to observe a change in the swallowing pattern where the bolus is held on the floor of the mouth and picked up with the tongue tip as the oral phase is initiated. This is known as the lingual-palatal pattern.
-
How does the duration of the oral phase change with age?
The oral phase of swallowing tends to be slightly longer in older individuals compared to younger individuals. This may be due to age-related changes in muscle strength and coordination.
-
What are some common issues related to swallowing residue in older individuals?
With age, there is an increased frequency and extent of oral and pharyngeal residue, meaning that food and liquid may remain in the oral and pharyngeal cavities after swallowing. This can lead to increased risk of aspiration or other complications.
-
How does aging affect esophageal transit and clearance?
Esophageal transit and clearance, the process of food and liquid moving through the esophagus, tend to be slower in older individuals. This can result in a feeling of food sticking in the throat or a delayed emptying of the esophagus.
-
What changes occur in the cricopharyngeal opening with age?
The cricopharyngeal opening, which is responsible for allowing the passage of food from the pharynx to the esophagus, may become reduced in size and less flexible with age. This can contribute to difficulties in swallowing and may result in a sensation of food getting stuck in the throat.
-
What are some taste changes that occur with age?
With age, there is a reduction in the intensity of taste and smell. This can affect the perception of flavors and the overall enjoyment of food.
-
What nerve is the cough reflex from?
- Cranial Nerve X
-
What kind of a reflex is a cough reflex?
Protective reflex
-
A cough reflex can be both...
Can be reflexive or volitional
