50 Questions
What is dysphagia?
Loss of the ability to swallow (eat)
Food that has been processed through mastication and shaped with saliva (enzymes) before swallowing is known as _____?
A bolus
Peristalsis truly occurs in the pharynx.
False
What is the term for the leftover food/liquid that remains after an attempt is made to pass the bolus through the oral cavity, pharynx, and esophagus?
Stasis
What are the three majors types of dysphagia?
Neurogenic Psychogenic Mechanical/anatomical
This type of dysphagia is caused by a mental disorder such as anorexia from psychosis, neurosis; also by anxiety disorders
Psychogenic
What is neurogenic dysphagia?
Difficulty swallowing due to damage to the nervous system that interfere with chewing or swallowing caused by strokes, TBI, CVA, CP, tumors
Mechanical/anatomic dysphagia is the inability to chew or swallow due to damage to the anatomic structure(s) preventing the mechanical processing of food. Please provide two examples
Trauma to the throat Chemical damage Cancer Fistula in trachea Allergy
Provide 2 examples of the underlying etiologies that cause acute dysphagia.
CVA, TBI
Provide 2 examples of the underlying etiologies that cause progressive dysphagia.
tumors, progressive neurological disease
What causes dysphagia? (Dr.B's Swallowing 7)
Decreased neural drive to the swallowing musculature Insufficient sensory feedback for efficient motor control Myofascial restrictions as result of the disease Disruption of air-flow gradients Anatomical changes to the swallowing musculature Muscle atrophy Changes in cognition and executive function
Provide 4 signs/symptoms of dysphagia:
Coughing before, during, and/or after meals Gurgly/wet vocal quality Inability to recognize food Difficulty placing food in mouth
What are the three stages of swallowing?
Oral (anticipatory + oral preparatory) Pharyngeal Esophageal
Swallowing requires both anatomical and physiological control
True
Neural control is mediated by the cortex and brainstem. Where is the swallowing center?
Medulla
The muscle of the soft palate help prevent food from entering into the nasopharynx as well as prematurely entering the pharynx*
True
What items/actions are responsible and help propel food through the pharynx?
Propulsive action of tongue Stipping actions of pharyngeal constrictors Presence of negative pressure in the hypopharynx Presence of positive pressure in the oropharynx
During the _____ phase of swallowing, the hyoid is pulled up, which in turn elevates the larynx; The arytenoids move anteriorly to make contact with the epiglottis and close the laryngeal opening.
Pharyngeal
During the ____ phase of swallowing, individuals obtain pleasure from the taste, texture, temperature, and weight of the bolus
Oral
The esophageal stage of swallowing commences with the elevation of the larynx and constriction of the muscles of the the upper esophageal sphincter or segment (UES)
False
Which muscles are included in the suprahyoid muscle group?
Anterior belly of the diagastric Stylohyoid Mylohyoid Geniohyoid
The extrinsic muscles serve as an “anchor” for the larynx.
True
What two muscle groups are extrinsic?
Suprahyoids Infrahyoids
What muscles are a part of the infrahyoids?
Sternohyoid Omohyoid Sternothyroid Thyrohyoid
Infrahyoids should be stimulated during therapy
False
This muscles depresses and retracts the tongue; makes the dorsum more convex
Hyoglossus
This muscle prevents the bolus from leaking out of the mouth during the oral phase.
Orbicularis oris
In the posterior oral cavity, it is the most stimulable area to trigger a swallow
Faucial arches
Large u-shaped bone; attachment for extrinsic laryngeal muscles
Mandible
What is the space created by the base of tongue and anterior side of epiglottis?
Vallculae
This CN is responsible for tongue function. Also the only cranial nerve that provides motor function.
Hypoglossal (XII)
This cranial nerve innervates the muscles of mastication and the mandible
Trigeminal (V)
This cranial nerve provides sensation to the face, nose, and mouth as well as taste sensation to the anterior ⅔ of the tongue.
Facial
This nerve provides sensation to the posterior ⅓ of the tongue; motor supply to the stylopharyngeus muscle (elevates the pharynx during swallowing)
Glossopharyngeal
What is the space created by the cricoid cartilage (anterior) and inferior pharyngeal constrictor and cricopharyngeal muscle as base? (pyramid shaped)
Pyriform sinues
This cranial nerve mediates the cough response and sensation in the pharynx
Vagus
Match the swallowing process to its responsible cranial nerve
Mouth opens to allow entry of bolus; Sensation of bolus within oral cavity = CN V Lips seal bolus within oral cavity; Salivation = CN VII Food collected and moved anteriorly to teeth; Bolus pushed up and back against soft palate; Hyoid elevates and moves anteriorly to bring larynx up beneath tongue = CN XII Sensation of arrival of bolus at palate = CN IX
U-shaped bone positioned horizontally in the neck at the level of C3
Hyoid
Match the muscle to its primary movement.
Digastric anterior belly = open the mandible during chewing Mylohyoid = raises the floor of the mouth and aids in pulling the hyoid forward Geniohyoid = weak depressor of the mandible External (lateral) pterygoid = assists in grinding motion
Which is the main muscle of chewing?
Masseter
Match the muscle to its movement
Superior longitudinal = shorten the tongue and move the lateral boundary upwards Verticalis = Contraction flattens the tongue Transversus = Contraction narrows and elongates the tongue Inferior longitudinal = Contraction shortens the tongue and pulls the tip downwards
Musculomembranous tube from skull to level of cricoid cartilage centrally and C6 dorsally
Pharynx
The primary function of the larynx is to produce speech.
False
Covered by mucous membrane that has characteristic folds
Larynx
Match the structure to its description
Thyroid cartilage = largest and most prominent cartilage of the larynx Cricoid = ring-like cartilage encircling the larynx immediately beneath thyroid cartilage Arytenoid = “small pyramids”; make up large portion of VF Epiglottis = serves to close the opening the larynx during swallowing
The “airspace” above the level of the VF that is bounded by the posterior surface of the epiglottis; it is wide and triangular in shape.
Laryngeal vestibule
Area of upper digestive tract that forms a barrier between the esophagus and the pharynx
Upper esophageal sphincter (UES)
During this phase, rotary and lateral tongue movements control placement of the bolus on the teeth and within the oral cavity.
Phase 1 - Oral
The ______ phase is a series of steps occurring in well-organized, efficient, rapid manner to allow for safe, effective swallowing. This involuntary stage takes less than 1 sec.
Pharyngeal
Closure of the TVF occurs as the ______ tilt up and forward; at the same time, the tongue moves _________ to the close laryngeal vestibule.
Esophageal
Study Notes
Dysphagia and Swallowing
- Dysphagia is a swallowing disorder that can be classified into three major types: oropharyngeal, esophageal, and functional.
- Bolus is food that has been processed through mastication and shaped with saliva (enzymes) before swallowing.
- Peristalsis truly occurs in the pharynx.
Types of Dysphagia
- Functional dysphagia is caused by a mental disorder such as anorexia from psychosis, neurosis, or anxiety disorders.
- Neurogenic dysphagia is caused by damage to the central or peripheral nervous system.
- Mechanical/anatomic dysphagia is the inability to chew or swallow due to damage to the anatomic structure(s) preventing the mechanical processing of food.
- Examples: tumor, surgery, radiation, and head and neck cancer.
Causes of Dysphagia
- Acute dysphagia can be caused by underlying etiologies such as stroke, traumatic brain injury, or spinal cord injury.
- Progressive dysphagia can be caused by underlying etiologies such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), or multiple sclerosis.
- Dysphagia can be caused by a variety of factors, including neural, muscular, and anatomic abnormalities.
Signs and Symptoms of Dysphagia
- Coughing or choking during eating
- Difficulty swallowing
- Regurgitation of food
- Weight loss or dehydration
Stages of Swallowing
- Oral phase: food is manipulated in the mouth and formed into a bolus
- Pharyngeal phase: the bolus is propelled through the pharynx and into the esophagus
- Esophageal phase: the bolus is propelled through the esophagus and into the stomach
Anatomy and Physiology of Swallowing
- The swallowing center is located in the brainstem.
- The cortex and brainstem mediate neural control of swallowing.
- The soft palate helps prevent food from entering the nasopharynx and prematurely entering the pharynx.
- The suprahyoid muscle group, including the geniohyoid, mylohyoid, and digastric muscles, helps propel food through the pharynx.
- The hyoid bone and larynx move up and forward during the pharyngeal phase.
- The epiglottis closes the laryngeal opening during the pharyngeal phase.
- The extrinsic muscles, including the stylohyoid, stylopharyngeus, and salpingopharyngeus muscles, serve as an "anchor" for the larynx.
- The infrahyoid muscles, including the sternothyreoideus, sternohyoideus, and omohyoideus muscles, help depress the larynx.
- The tongue is depressed and retracted by the genioglossus muscle.
- The posterior oral cavity is the most stimulable area to trigger a swallow.
Cranial Nerves and Swallowing
- Cranial nerve XII (hypoglossal nerve) is responsible for tongue function.
- Cranial nerve V (trigeminal nerve) provides sensation to the face, nose, and mouth as well as taste sensation to the anterior ⅔ of the tongue.
- Cranial nerve IX (glossopharyngeal nerve) provides sensation to the posterior ⅓ of the tongue and motor supply to the stylopharyngeus muscle.
- Cranial nerve X (vagus nerve) mediates the cough response and sensation in the pharynx.
Additional Notes
- The larynx is a musculomembranous tube that produces speech.
- The cricopharyngeal muscle forms a pyramid-shaped space with the cricoid cartilage.
- The vallecula is the space created by the base of the tongue and the anterior side of the epiglottis.
- The pyriform sinus is the "airspace" above the level of the vallecula that is bounded by the posterior surface of the epiglottis.
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