Swallowing Anatomy and Physiology
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Questions and Answers

What is dysphagia?

  • Process of chewing food
  • Loss of the ability to swallow (eat) (correct)
  • Food that has been processed through mastication and shaped with saliva enzymes before swallowing
  • Bolus moved from oral, pharyngeal, and esophageal structures (truly happens in the esophagus)

    • Food that has been processed through mastication and shaped with saliva (enzymes) before swallowing is known as _____?

  • A bolus (correct)
  • Peristalsis
  • Stasis
  • Residue

    • 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?

    <p>Stasis</p> Signup and view all the answers

    What are the three majors types of dysphagia?

    <p>Neurogenic Psychogenic Mechanical/anatomical</p> Signup and view all the answers

    This type of dysphagia is caused by a mental disorder such as anorexia from psychosis, neurosis; also by anxiety disorders

    <p>Psychogenic</p> Signup and view all the answers

    What is neurogenic dysphagia?

    <p>Difficulty swallowing due to damage to the nervous system that interfere with chewing or swallowing caused by strokes, TBI, CVA, CP, tumors</p> Signup and view all the answers

    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

    <p>Trauma to the throat Chemical damage Cancer Fistula in trachea Allergy</p> Signup and view all the answers

    Provide 2 examples of the underlying etiologies that cause acute dysphagia.

    <p>CVA, TBI</p> Signup and view all the answers

    Provide 2 examples of the underlying etiologies that cause progressive dysphagia.

    <p>tumors, progressive neurological disease</p> Signup and view all the answers

    What causes dysphagia? (Dr.B's Swallowing 7)

    <p>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</p> Signup and view all the answers

    Provide 4 signs/symptoms of dysphagia:

    <p>Coughing before, during, and/or after meals Gurgly/wet vocal quality Inability to recognize food Difficulty placing food in mouth</p> Signup and view all the answers

    What are the three stages of swallowing?

    <p>Oral (anticipatory + oral preparatory) Pharyngeal Esophageal</p> Signup and view all the answers

    Swallowing requires both anatomical and physiological control

    <p>True</p> Signup and view all the answers

    Neural control is mediated by the cortex and brainstem. Where is the swallowing center?

    <p>Medulla</p> Signup and view all the answers

    The muscle of the soft palate help prevent food from entering into the nasopharynx as well as prematurely entering the pharynx*

    <p>True</p> Signup and view all the answers

    What items/actions are responsible and help propel food through the pharynx?

    <p>Propulsive action of tongue Stipping actions of pharyngeal constrictors Presence of negative pressure in the hypopharynx Presence of positive pressure in the oropharynx</p> Signup and view all the answers

    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.

    <p>Pharyngeal</p> Signup and view all the answers

    During the ____ phase of swallowing, individuals obtain pleasure from the taste, texture, temperature, and weight of the bolus

    <p>Oral</p> Signup and view all the answers

    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)

    <p>False</p> Signup and view all the answers

    Which muscles are included in the suprahyoid muscle group?

    <p>Anterior belly of the diagastric Stylohyoid Mylohyoid Geniohyoid</p> Signup and view all the answers

    The extrinsic muscles serve as an “anchor” for the larynx.

    <p>True</p> Signup and view all the answers

    What two muscle groups are extrinsic?

    <p>Suprahyoids Infrahyoids</p> Signup and view all the answers

    What muscles are a part of the infrahyoids?

    <p>Sternohyoid Omohyoid Sternothyroid Thyrohyoid</p> Signup and view all the answers

    Infrahyoids should be stimulated during therapy

    <p>False</p> Signup and view all the answers

    This muscles depresses and retracts the tongue; makes the dorsum more convex

    <p>Hyoglossus</p> Signup and view all the answers

    This muscle prevents the bolus from leaking out of the mouth during the oral phase.

    <p>Orbicularis oris</p> Signup and view all the answers

    In the posterior oral cavity, it is the most stimulable area to trigger a swallow

    <p>Faucial arches</p> Signup and view all the answers

    Large u-shaped bone; attachment for extrinsic laryngeal muscles

    <p>Mandible</p> Signup and view all the answers

    What is the space created by the base of tongue and anterior side of epiglottis?

    <p>Vallculae</p> Signup and view all the answers

    This CN is responsible for tongue function. Also the only cranial nerve that provides motor function.

    <p>Hypoglossal (XII)</p> Signup and view all the answers

    This cranial nerve innervates the muscles of mastication and the mandible

    <p>Trigeminal (V)</p> Signup and view all the answers

    This cranial nerve provides sensation to the face, nose, and mouth as well as taste sensation to the anterior ⅔ of the tongue.

    <p>Facial</p> Signup and view all the answers

    This nerve provides sensation to the posterior ⅓ of the tongue; motor supply to the stylopharyngeus muscle (elevates the pharynx during swallowing)

    <p>Glossopharyngeal</p> Signup and view all the answers

    What is the space created by the cricoid cartilage (anterior) and inferior pharyngeal constrictor and cricopharyngeal muscle as base? (pyramid shaped)

    <p>Pyriform sinues</p> Signup and view all the answers

    This cranial nerve mediates the cough response and sensation in the pharynx

    <p>Vagus</p> Signup and view all the answers

    Match the swallowing process to its responsible cranial nerve

    <p>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</p> Signup and view all the answers

    U-shaped bone positioned horizontally in the neck at the level of C3

    <p>Hyoid</p> Signup and view all the answers

    Match the muscle to its primary movement.

    <p>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</p> Signup and view all the answers

    Which is the main muscle of chewing?

    <p>Masseter</p> Signup and view all the answers

    Match the muscle to its movement

    <p>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</p> Signup and view all the answers

    Musculomembranous tube from skull to level of cricoid cartilage centrally and C6 dorsally

    <p>Pharynx</p> Signup and view all the answers

    The primary function of the larynx is to produce speech.

    <p>False</p> Signup and view all the answers

    Covered by mucous membrane that has characteristic folds

    <p>Larynx</p> Signup and view all the answers

    Match the structure to its description

    <p>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</p> Signup and view all the answers

    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.

    <p>Laryngeal vestibule</p> Signup and view all the answers

    Area of upper digestive tract that forms a barrier between the esophagus and the pharynx

    <p>Upper esophageal sphincter (UES)</p> Signup and view all the answers

    During this phase, rotary and lateral tongue movements control placement of the bolus on the teeth and within the oral cavity.

    <p>Phase 1 - Oral</p> Signup and view all the answers

    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.

    <p>Pharyngeal</p> Signup and view all the answers

    Closure of the TVF occurs as the ______ tilt up and forward; at the same time, the tongue moves _________ to the close laryngeal vestibule.

    <p>Esophageal</p> Signup and view all the answers

    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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