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42 Cards in this Set

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Whats involved with bolus containment?

Muscles, Action, CN
1. Orbicularis oris
2. Incisivus labii

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

CN-VII
What face/tongue muscles are involved with bolus control?

CNs?
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
What's involved in RAISING the mandible for mastication?

Muscles, CN
1. Masseter
2. Medial Pterygoid
3. Temporalis

CN-V
What's involved in LOWERING the mandible for mastication? (4)
1. Lateral Pterygoid (CN V)
2. Anterior belly of Digastric (CN V)
3. Geniohyoid (CN XII)
4. Mylohyoid (CN V)
What facial muscles are involved in lip movement coordination with jaw & tongue during mastication? (6)

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

CN-VII
Orbicularis Oris
(superior and inferior)
Press lips together and obliterate anterior labial sulcus during onset of
bolus transport

CN-VII
What is the BUCCAL (buccinator) muscle do to aid in swallowing?
Compresses/tenses cheeks against the teeth (whistling); obliterates lateral sulci during onset of bolus transport

CN- VII
What does the Genioglossus & Intrinsic Lingual muscles do?

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

CN- XII
Which CN is involved of SENSATION of lips, cheeks, ant. 2/3 of tongue, palate, gums, and FOM?
CN- V
Which CN is involved of SENSATION of 1/3 post. of tongue?
CN-V (2/3)
CN- IX (1/3)
What two CNs are involved in taste?
CN-VII: anterior 2/3 of tongue

CN-IX: posterior 1/3 of tongue
What CN and muscles are involved in ELEVATING the velum during VPC? (2)
CN: X

1. Levator veli palatini
2. Musculus uvulae
What CN and muscles are involved in TENSING ANTERIOR VELUM & OPENING the AUDITORY TUBE during VPC?
CN: V

Tensor Veli Palatini
What CN and muscles move the lateral pharyngeal walls medially and create Passavant's pad on posterior pharyngeal wall?
CN: IX, X

1. Superior Constrictor
2. Horizontal fibers of palatopharyngeus
Which CNs and muscles are involved in progressive CONTRACTION & ELEVATION of PHARYNX? (3)
CN: IX, X
(Pharyngeal Plexis)

1. Superior, Middle and Inferior Constrictor
2. Salpinogpharyngeus
3. Sylopharyngeus (CN: IX)
Which muscles ELEVATE & ANTERIOR displace HYOID?
(3)
1. Ant. belly of Digastric (CN-V)
2. Mylohyoid (CN-V)
3. Geniohyoid (CN-XII)
Which CN/muscles ADDuct the VFs to protect the larynx? (3)
CN- X
1. Interarytenoids (transverse & oblique)
2. Lateral Cricoarytenoid (LCA)
2. Thyroartenoid (body of VF)
Which CN/muscles INVERT EPIGLOTTIS to protect the larynx?
CN-X
1. Thyrohyoid
2. Possibly Aryeppiglottic
What is a major contributor of UES opening & is part of the inferior pharyngeal constrictor?
Cricopharyngeus

Its attached anteriorly to the laminae of the cricoid cartilage.
Does the UES relax or tense during the swallow?
Relax
Which CN deals with both the motor & sensory of cough?
CN: X (input and output)
Which CNs deals with both the motor & sensory of gag-reflex?
CN: IX (sensory) - input
CN: X (motor) - output
What are some changes associated with NORMAL AGING & SWALLOW?
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
Can dysphagia & aspiration be a consequence to normal aging?
NEVER
How many seconds is normal for ORAL STAGE? PHARYNGEAL STAGE? ESOPHAGEAL STAGE?
ORAL: 1-1.5 seconds

PHARYNGEAL: ~1 second

ESOPHAGEAL: 8-12 seconds
During what stage of the swallow does the epiglottis retracts to cover entrance of the larynx?

What happens next in this stage?
Pharyngeal stage

The CRICOPHARYNGEAL relaxes (UES opens)
What are 4 protective mechanisms regarding airway and prevents aspiration?
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
Which neurogenic disease results in spasticity and incoordination of oropharyngeal and respiratory muscles creating functional problems with swallowing?
Multiple Sclerosis (demyelinating disease

Autoimmune process that involves destruction of MYELIN; Nerve impluses slowed or halted.
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)?
Huntington's Disease (Extrapyramidal Tract)
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?
Parkinson's Disease (Extrapyramidal Tract)
Which neurogenic disorder always results dysphagia and exercises are contraindicated because they lead to future fatigue of musculature?
ALS
Which neurogenic disorder results in progressive fatigue with use and often affects muscles innervated by the bulbar nuclei?

What is recommend for this disease?
Myasthenia Gravis

MBS before & after meal in order to evaluate disorder when symptoms present
What is the term for dry mouth?
Xerostomia
How does a trach effect swallowing?
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
What does DYSPENIA mean?
Difficulty breathing
What is Zenker's Diverticulum?
Outpouching or pocket that forms:
- in the pharyngeal wall just superior to UES
- Within the UES
- Below the UES
What is Achalasia?
Failure of the LES to relax which prevents passage of the bolus into stomach
What is important about the FEES?
(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
When should you use an fluoroscopy?
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)
Whats the difference b/w Tracheostomy vs. Tracheotomy?
Tracheostomy: incision of the skin

Tracheotomy: permanent opening
What are some compensatory maneuvers for swallowing? (7)
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.
Palatal Lift vs. Palatal Obturator vs. Palatal Augmentation
Palatal Lift- lifts palate into elevated position

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

Palatal Augmentation: lowering hard palate to allow tongue contact