Swallowing

Front 1

Whats involved with bolus containment?

Muscles, Action, CN

Back 1

1. Orbicularis oris
2. Incisivus labii

- Provide anterior seal of lips, especially for larger boluses, highly active during straw suck

CN-VII

Front 2

What face/tongue muscles are involved with bolus control?

CNs?

Back 2

1. Buccinator (compresses cheeks against teeth/aids in mastication) CN-VII
2. Risorius (retracts angle of mouth to produce smile) CN-VII

3. Genioglossus (chin to tongue; depresses & protrudes tongue) CN-XII

4. Intrinsic tongue muscles (superior longitudinal, inferior longitudinal, vertical, transverse muscle) CN-XII

Front 3

What's involved in RAISING the mandible for mastication?

Muscles, CN

Back 3

1. Masseter
2. Medial Pterygoid
3. Temporalis

CN-V

Front 4

What's involved in LOWERING the mandible for mastication? (4)

Back 4

1. Lateral Pterygoid (CN V)
2. Anterior belly of Digastric (CN V)
3. Geniohyoid (CN XII)
4. Mylohyoid (CN V)

Front 5

What facial muscles are involved in lip movement coordination with jaw & tongue during mastication? (6)

CN?

Back 5

1. Levator Anguli Oris
2. Levator Labii Superioris
3. Depressor Anguli Oris
4. Depressor Labii Inferioris
5. Zygomaticus
6. Mentalis

CN-VII

Front 6

Orbicularis Oris
(superior and inferior)

Back 6

Press lips together and obliterate anterior labial sulcus during onset of
bolus transport

CN-VII

Front 7

What is the BUCCAL (buccinator) muscle do to aid in swallowing?

Back 7

Compresses/tenses cheeks against the teeth (whistling); obliterates lateral sulci during onset of bolus transport

CN- VII

Front 8

What does the Genioglossus & Intrinsic Lingual muscles do?

CN?

Back 8

Create channel in midline of tongue; progressive and sequential pressing of tongue against palate

CN- XII

Front 9

Which CN is involved of SENSATION of lips, cheeks, ant. 2/3 of tongue, palate, gums, and FOM?

Back 9

CN- V

Front 10

Which CN is involved of SENSATION of 1/3 post. of tongue?

Back 10

CN-V (2/3)
CN- IX (1/3)

Front 11

What two CNs are involved in taste?

Back 11

CN-VII: anterior 2/3 of tongue

CN-IX: posterior 1/3 of tongue

Front 12

What CN and muscles are involved in ELEVATING the velum during VPC? (2)

Back 12

CN: X

1. Levator veli palatini
2. Musculus uvulae

Front 13

What CN and muscles are involved in TENSING ANTERIOR VELUM & OPENING the AUDITORY TUBE during VPC?

Back 13

CN: V

Tensor Veli Palatini

Front 14

What CN and muscles move the lateral pharyngeal walls medially and create Passavant's pad on posterior pharyngeal wall?

Back 14

CN: IX, X

1. Superior Constrictor
2. Horizontal fibers of palatopharyngeus

Front 15

Which CNs and muscles are involved in progressive CONTRACTION & ELEVATION of PHARYNX? (3)

Back 15

CN: IX, X
(Pharyngeal Plexis)

1. Superior, Middle and Inferior Constrictor
2. Salpinogpharyngeus
3. Sylopharyngeus (CN: IX)

Front 16

Which muscles ELEVATE & ANTERIOR displace HYOID?
(3)

Back 16

1. Ant. belly of Digastric (CN-V)
2. Mylohyoid (CN-V)
3. Geniohyoid (CN-XII)

Front 17

Which CN/muscles ADDuct the VFs to protect the larynx? (3)

Back 17

CN- X
1. Interarytenoids (transverse & oblique)
2. Lateral Cricoarytenoid (LCA)
2. Thyroartenoid (body of VF)

Front 18

Which CN/muscles INVERT EPIGLOTTIS to protect the larynx?

Back 18

CN-X
1. Thyrohyoid
2. Possibly Aryeppiglottic

Front 19

What is a major contributor of UES opening & is part of the inferior pharyngeal constrictor?

Back 19

Cricopharyngeus

Its attached anteriorly to the laminae of the cricoid cartilage.

Front 20

Does the UES relax or tense during the swallow?

Back 20

Relax

Front 21

Which CN deals with both the motor & sensory of cough?

Back 21

CN: X (input and output)

Front 22

Which CNs deals with both the motor & sensory of gag-reflex?

Back 22

CN: IX (sensory) - input
CN: X (motor) - output

Front 23

What are some changes associated with NORMAL AGING & SWALLOW?

Back 23

1. Tongue muscle atrophy (leads to reduced lingual propulsion)
2. Hardening of flexible cartilages & ossification
3.Larynoptosis- Sagging of larynx
4. Increased transit times (delayed0
5. Residue increased
6. UES opening reduced
7. Swallow response time delayed
8. Frequent penetration into airway but NEVER beyond VFs (aspiration is NEVER normal)
9. Reduced sensations
10. Reduced cough reflex

Front 24

Can dysphagia & aspiration be a consequence to normal aging?

Back 24

NEVER

Front 25

How many seconds is normal for ORAL STAGE? PHARYNGEAL STAGE? ESOPHAGEAL STAGE?

Back 25

ORAL: 1-1.5 seconds

PHARYNGEAL: ~1 second

ESOPHAGEAL: 8-12 seconds

Front 26

During what stage of the swallow does the epiglottis retracts to cover entrance of the larynx?

What happens next in this stage?

Back 26

Pharyngeal stage

The CRICOPHARYNGEAL relaxes (UES opens)

Front 27

What are 4 protective mechanisms regarding airway and prevents aspiration?

Back 27

1. Retraction of epiglottis
2. Elevation & forward movement of hyoid and larynx
3. Adduction of true vocal folds
4. Sphincter squeezing/closure of laryngeal vestibule

Front 28

Which neurogenic disease results in spasticity and incoordination of oropharyngeal and respiratory muscles creating functional problems with swallowing?

Back 28

Multiple Sclerosis (demyelinating disease

Autoimmune process that involves destruction of MYELIN; Nerve impluses slowed or halted.

Front 29

dysphagia signs stem from the oral and
Which neurogenic disease results in pharyngeal stage disorders of lingual chorea and tachyphagia (abnormally rapid eating or bolting of food)?

Back 29

Huntington's Disease (Extrapyramidal Tract)

Front 30

Which neurogenic disease results in rigidity and impaired lingual movement, minimal jaw opening, abnormal head and neck posture, and impulsive eating behavior and may even have silent aspiration?

Back 30

Parkinson's Disease (Extrapyramidal Tract)

Front 31

Which neurogenic disorder always results dysphagia and exercises are contraindicated because they lead to future fatigue of musculature?

Back 31

ALS

Front 32

Which neurogenic disorder results in progressive fatigue with use and often affects muscles innervated by the bulbar nuclei?

What is recommend for this disease?

Back 32

Myasthenia Gravis

MBS before & after meal in order to evaluate disorder when symptoms present

Front 33

What is the term for dry mouth?

Back 33

Xerostomia

Front 34

How does a trach effect swallowing?

Back 34

1. Decreased laryngeal elevation
2. Desensitize cough
3. 6+ months can form scar tissue which can reduce true VF closure
4. Inflatted cuff can put pressure on cervical esophageal wall effecting bolus transpot and cause excess pooling
5. Decreased subglottic pressure

Front 35

What does DYSPENIA mean?

Back 35

Difficulty breathing

Front 36

What is Zenker's Diverticulum?

Back 36

Outpouching or pocket that forms:
- in the pharyngeal wall just superior to UES
- Within the UES
- Below the UES

Front 37

What is Achalasia?

Back 37

Failure of the LES to relax which prevents passage of the bolus into stomach

Front 38

What is important about the FEES?

Back 38

(Flexible Endoscopic Eval of Swallow)

Placed in nose to view the swallow immediately before and after triggering of swallow reflex

Can view VP closure, structual integrity of larynx/pharynx, excess secretions, sensation, and true VF adduction/abduction

Can be good for BIOFEEDBACK

Front 39

When should you use an fluoroscopy?

Back 39

videofluoroscopy = (MBS)

Visualizes bolus during oral phase, completeness of tongue retraction, UES opening, laryngeal elevation, extent of Aspiration, and structural changes (due to injury/surgery)

Front 40

Whats the difference b/w Tracheostomy vs. Tracheotomy?

Back 40

Tracheostomy: incision of the skin

Tracheotomy: permanent opening

Front 41

What are some compensatory maneuvers for swallowing? (7)

Back 41

1. Chin Tuck- reduced spillage d/t gravity

2. Chin-Up

3. Head turn (r/l)- typ used when there residue on pyriform sinus & pharyngeal wall

4. Effortful swallow- promotes stronger tongue to palate contact & stronger BOT to posterior pharyngeal wall contact

5. Supraglottic swallow- helps to protect aspiration BEFORE swallow

6. Super Supraglottic swallow- effortful swallow + supraglottic swallow

7. Mendelsohn's Maneuver- voluntary holds laryngeal elevation (either by hand or muscles) for extended period of time.

Front 42

Palatal Lift vs. Palatal Obturator vs. Palatal Augmentation

Back 42

Palatal Lift- lifts palate into elevated position

Palatal Obturator- covers surgical defect, fistula, cleft, etc.

Palatal Augmentation: lowering hard palate to allow tongue contact