Dysphagia

Front 1

Dysphagia

Back 1

disorder of swallowing

Front 2

Swallowing

Back 2

entire act of deglutition; from placement of food into the mouth through the oral pharyngeal and esphageal stages until material enters the stomach through the gastroesphageal junction

Front 3

Deglutition

Back 3

the act or process of swallowing

Front 4

Feeding

Back 4

oral prepatory and oral stage of swallow; placement of food in the mouth

Front 5

Oral Cavity

Back 5

lips, teeth, hard and soft palate, uvula, mandible, floor and roof of mouth, anterior and lateral sulci, tongue, and faucial arches

Front 6

Floor of Mouth

Back 6

muscles attach to the mandible anteriorly and to the hyoid bone posteriorly

Front 7

Floor of Mouth

Back 7

a. myohyoid
b. geniohyoid
c. anterior belly of digastric
d. anterior and lateral sulci- pockets b/t the lip and mandible

Front 8

Tongue has 2 portiona

Back 8

Oral tongue (front of tongue) includes:
tip, blade, front, center, back
ends @ circumvallate papillae
active during speech and oral stage od swallow
cortical or voluntary control

Front 9

2nd portion of tongue

Back 9

Pharyngeal (base)
begins @ circumvallate papillae
involuntary neural control coordinated in brainstem

Front 10

what is the foundation of the tongue?

Back 10

hyoid bone

Front 11

formed by maxilla (hard palate), velum (soft palate), and uvula
- purpose of velar elevation

Back 11

roof of mouth

Front 12

what provides midline bulk on nasal side of velum that contarcts posterior pharyngeal wall during the swallow

Back 12

intrinsic muscle

Front 13

extrinsic muscles

Back 13

tensor veli palatini, levator veli palatinin, palatopharyngeus, palatoglossus

Front 14

tenses and elevates anterior velum

Back 14

tensor veli palatini

Front 15

moves velum superiorly and posteriorly

Back 15

levator veli palatini

Front 16

pulls velum inferiorly makes up the posterior faucial pillars

Back 16

palatopharyngeus

Front 17

pulls velum down and forward; makes up the anterior faucial pillars

Back 17

palatoglossus

Front 18

what are the 3 salivary glands

Back 18

parotid; submandibular;sublingual

Front 19

account for 2/3 of salica production when stimulated
produce serous (thin) and watery fluid

Back 19

parotid

Front 20

produce saliva during rest
produce serous and viscid (mucus-like) fluid

Back 20

submandibular

Front 21

produces both types of saliva

Back 21

sublingual

Front 22

what are the purposes of saliva

Back 22

keep oral cavity moist
buffer destructive acid produced by bacteria
reduce tooth decay by washing away plaque
add moisture to bolus during oral stage
neutralizes stomach acid that has refluxed into the esphagus

Front 23

the cricopharyngeal muscle attaches to the cricoid lamina to form the

Back 23

upper esophageal sphinceter (UES), aka cricopharyngeal regio (CP) and pharyngeoesphageal sphincter (PE segment)

Front 24

what is the most inferior structure of the pharynx

Back 24

cricopharyngeal muscle

Front 25

what forms the posterior and lateral walls

Back 25

superior constrictors, medial constrictors, and inferior constrictors.

Front 26

the anterior wall is formed by constrictor fiber that attach to what

Back 26

pterygoid plates on the sphenoid bone
sodr palate
base of tongue
mandible
hyoid bone
thyroid cartilage
cricoid cartilage

Front 27

upper esophageal sphinter (UES)

Back 27

a. top valve of the esophagues ALWAYS CLOSED
b. reduces refux from esphagues into pharynx
c. pressure vlave-greatest pressure during inspiration and immediately prior to swallow.. opens to allow bolus into esophagus

Front 28

what is the upper most structure of the larynx

Back 28

epiglottis

Front 29

how many levels of sphincters of the larynx are there

Back 29

3

Front 30

what is the space btwn base of tongue and epiglottis divided by the hyoepiglottic ligament

Back 30

valleculale

Front 31

what s the opening into the larynx; bound by epiglottis, aryepiglottic folds and artenoid cartilages

Back 31

laryngeal vestibule

Front 32

a. lateral walls of larybgeal vestibuls
b. attached laterally to epiglottis and extend posteriorly to surround arytenoid cartilages
--part of supraglottis

Back 32

aryepiglottic folds

Front 33

the elbows!
positioned posteriorly on the cricoid cartilages
muscular pull on these controls movement of true vocal cords

Back 33

arytenoid cartilages

Front 34

shelves of soft tissue superior but parallel with true vocal folds;aka ventricular folds

Back 34

false vocal folds

Front 35

space between false and true vocal folds

Back 35

laryngeal ventricles

Front 36

glottic level
last level of airway protection
composed of vocalis and thryoarytenoid muscle
attached from vocal processes of arytenoids posteriorly; throid lamina laterally; to thyroid notch anteriorly

Back 36

true vocal folds

Front 37

name the intrinsic muscles
4 pairs 1 single

Back 37

a. thyroarytenoids
b.cricothroids
c.lateral cricoarytenoid muscles
d. posterior cricoarytenoid muscles
e. interarytenoid muscle

Front 38

which intrinsic muscle makes up the bulk of vocal cord; and innervated by the recurrent laryngeal branch of the vagus nerve (CN X)

Back 38

thyroarytenoids

Front 39

which intrinsic muscle elongates the thryoartenoid muscle - and is the ONLY intrinsic laryngeal muscle innervated by the superior laryngeal branch of the vagus (X)

Back 39

cricothyroids

Front 40

which intrinsic muscle adducts the vocal folds by rotating the arytenoids dorward and is innervated by the recurrent laryngeal nerve

Back 40

lateral cricoarytenoid muscles

Front 41

which instrinsc muscles oppose the lateral cricothyroids - abduct the vocal folds by rotating the arytenoids away from midline and is innervated by the recurrent larungeal nervee

Back 41

posterior cricoartenoid

Front 42

which msucle attaches attaches between the arytenoid cartilages and adducts the arytenoids to close the vocal folds - innervated by the recurrent laryngeal nerve

Back 42

interarytenoid muscle

Front 43

a. connect the larynx to other structures in the head, neck, and chest
b. suspend and stabilize thyroid cartilage in the neck
c. elevates or depresses larynx as a whole

these are also known as strap muscles

Back 43

extrinsic muscles

Front 44

name the three valve levels for airway protection

Back 44

a. epiglottis and aryepiglottic folds
b. arytenoids and false vocal folds
c. true vocal cords

opens from the bottom up

Front 45

name and describe the four phases of swallowing

Back 45

1. oral prep phase: food is manipulated in the mouth to reduce food to a consistency which can be swallowed
2. oral phase: the tongue propels the bolus posteriorly until pharyngeal swallow is triggered
3. pharyngeal phase: once pharyngeal swallow is triggered bolus is transfered through pharynx
5. esophageal phase:bolus goes from UES through the esophagus to LES

Front 46

describe the oral prep phase

Back 46

-sensory info is pricessed throughout the mouth
-labial seal is maintaines and nasal airway is open
-volume of bolus swallowed varies with viscosity of the food
-bolus is either maintained as it went in or chewed
-if no chewing velum pulled down and forward to close off oral cavity from pharynx
-if bolus is chewed :tension in buccal musculature closes off lateral sulci - soft palateis not pulled down and forward - premature spillage is common and normal

Front 47

as bolus viscosity increases max volume swallowed

Back 47

decreases

Front 48

Oral Phase

Back 48

initated when tongue begins posterior propulsion of the bolus:
Req:
-intact labial musculature to maintain seal
-intact lingual movement to propel the bolus backward
-intact buccal tension to prevent pooling in the lateral sulci 0normal palatal muscles0ability to breathe thru the nose

tongue tip and sides are anchored to alveolar ridge and groove is formed to push the bolus backward

as viscosity increases GREATER lingual pressure is need to propel bolus

TAKES LESS thank 1 to 1.5 sec

Front 49

NO pharyngeal swallow will occur until

Back 49

the pharyngeal swallow is triggered

Front 50

oral stage ends whn

Back 50

the bolus passes btwn the anterior faucial arches and or where the tongue base crosses the lower rim of the mandible - triggering the pharybgeal swallow

Front 51

True or false :
having something in teh mouth triggers a swallow

Back 51

FALSE

Front 52

6 steps of the Pharyngeal Phase

Back 52

1. complete closure of velopharyngeal port
2. elevation and anterior movement of hyoid and larynx
3. closure of larynx
4. cricopharyngeal opening
5. complete contact is made btwn the tongue base and pressure builds - comete contact is btwn the tongue base and posterior pharungeal wall and bolus is pushed to the ues
6. progressive to to bottom contraction in the pharyngeal constrictors.

Front 53

bolus enters thru the cricopharyngeal juncture or UES

Back 53

ESOPHAGEAL PHASE

Front 54

true or false
videofluoroscopic study usually does not involve examination of esophagus; referred for a standard barium swallow or upper G-I series

Back 54

TRUE

Front 55

if pharyngeal trigger does not occur

Back 55

bolus may be propelled into the pharynx and rest in the valleculae or pyriform sinuses
0if liquid, it may get into the airway
if patient's sensitivity is in tact coughing will occur to expectorate the bolus

Front 56

what are the variations of normal swallowing

Back 56

-volume effect
-increasing viscosity
-cup drinking
-pharyngeal swallow with no oral phase-premature spillage
-chugging

Front 57

explain chugging

Back 57

pull larynx forward, open ues volitionally, hold breath to close airway, then dump by gravity into pharynx and down the esophagus

Front 58

what are some of the changes in older adults

Back 58

-reduction in strength of pharyngeal contraction may cause 2nd swallow
- slightly longer oral phase
- reduced smell and taste

Front 59

what causes a 2nd swallow in older adults

Back 59

-ossification of the cartilages
-cervical arthritis
-lowering of larynx in the neck

Front 60

what are some of the consequences of swallowing impairment

Back 60

-aspiration pneumonia
-malnutrition
-dehydration
-death

Front 61

pt complains food sticks high in throat -points to base of tongue

Back 61

material likely hesitates in valleculae @ tongue base
reduced hyoid/laryngeal elevation

Front 62

pt complains food gets stuck in throat below larynx

Back 62

material likely pooling in pyriform sinuses
possible esophageal disorder

Front 63

pt complains cough and choke

Back 63

laryngeal penetration adn or aspiration

Front 64

pt says liquids are easier than solids to swallow

Back 64

poor oral control lingual weakness

Front 65

pt says dry and thick foods hard to swallow

Back 65

poor oral hydration-lingual weakness

Front 66

pt says food spreads in mouth

Back 66

poor bolus formation/propulsion

Front 67

choke on liquids - do better w thicker consistencies

Back 67

delayed triggering of pharyngeal swallow

Front 68

pt says food/liquid coming out of nose

Back 68

poor velar closure during swallow

Front 69

pt says food/liquid falling from mouth

Back 69

poor lip seal/oral containment

Front 70

something stuck in throat

Back 70

globus sensation

Front 71

pt says throat burns on swallow

Back 71

reflux

Front 72

pt says food returns to mouth in orgnal condition

Back 72

pharyngeal pocket/ zenker's diverticulum