Dysphagia Midterm Diagram | Quizlet

TERM

Nasopharynx

DEFINITION

region behind the nasal cavity, above the soft palate

TERM

oropharynx

DEFINITION

region behind the oral cavity, includes tongue base and valleculae

TERM

hypopharynx

DEFINITION

lower pharynx, includes pyriform sinuses and leadds to UES

TERM

trachea

LOCATION

TERM

nasal cavity

DEFINITION

uppermost airway chamber above the soft palate

TERM

tongue

LOCATION

TERM

soft palate

DEFINITION

posterior portion of the palate; elevates during swallowing

TERM

mandible

DEFINITION

lower jaw bone forming the inferior boundary of the oral cavity

TERM

tongue base

DEFINITION

posterior third of the tongue; critical for pharyngeal propulsion

TERM

epiglottis

DEFINITION

leaf-shaped cartilage that inverts to protect airway

TERM

vallecular sinus

DEFINITION

space between tongue base and epiglottis

TERM

pyriform sinus

DEFINITION

bilateral recesses in the hypopharynx lateral to the larynx

TERM

hyoid bone

DEFINITION

floating bone anchoring suprahyoid muscles; elevates larynx

TERM

larynx

DEFINITION

airway structure containing vocal folds; elevates during swallow

TERM

posterior pharyngeal wall

DEFINITION

muscular wall behind the pharynx; contracts during peristalis

TERM

upper esophageal sphincter UES

DEFINITION

cricopharyngeus muscle; relaxes to allow bolus entry into esophagus

dysphagia

difficulty in swallowing

aphagia

inability to swallow anything

consequences of swallowing disorders

aspiration

aspiration pneumonia

dehydration

malnutrion

weight loss

aspiration (possible resulting conditions related to dysphagia)

food, liquid, pills secretions pass BELOW the level of the vocal folds, before, during, or after the swallow

aspiration pneumonia

pulmonary infection due to aspiration

true/false: aspiration may be overt or silent

true

penetration

the presence of food or fluids down near the vocal folds but NOT below the vocal folds

true/false: in some cases, there is penetration but not aspiration

true

dehydration (possible resulting conditions related to dysphagia)

drying meds, forgetting to drink, perspiration

malnutrition (possible resulting conditions related to dysphagia)

inability to ingest safely, fear of eating, poor digestion/absorbtion

weight loss (possible resulting conditions related to dysphagia)

unplanned, associated with muscle loss, may indicate underlying medical condition, fear of eating/drinking due to past swallowing problems

may be limitations on the types of food that a patient can swallow safely

functional limitation (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

patients may be limited to a specific diet of foods they do not like

functional limitations (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

time required to swallow and finish a meal may take longer

functional limitations (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

oral structures may limit the types of food to swallow

functional limitations (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

some food may cause the patient to stroke

functional limitation (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

awarenes due to either visual or conscious limitations restrict eating

functional limitation: (Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally)

gastric structures or functions may limit the amount or type of foods

functional limitation: Functional limitations are the direct, practical problems a person experiences because their swallow is not working normally

patients on a nonoral diet may be reluctant to attend events where food is served

activities and participation: the real‑world things a person can or cannot do because of their swallowing disorder.

foods related to culture or religon may not be available to the patient

activities and participation: the real‑world things a person can or cannot do because of their swallowing disorder.

ability to hold and use a straw or utensils may limit eating/drinking

activities and participation: the real‑world things a person can or cannot do because of their swallowing disorder.

ability to eat in a group setting may limit activities

activities and participation: the real‑world things a person can or cannot do because of their swallowing disorder.

ability to prepare meals may reduce food intake

activities and participation: the real‑world things a person can or cannot do because of their swallowing disorder.

changes in room lighting or sound may limit eating

environmental factors: the external conditions that make swallowing easier or harder.

proper eating arrangements may be limited due to room spaces

environmental factors: the external conditions that make swallowing easier or harder.

eating in public may present unwanted attention

environmental factors: the external conditions that make swallowing easier or harder.

use of personal care providers may be needed during mealtimes

environmental factors: the external conditions that make swallowing easier or harder.

ability to prepare food may be limited

environmental factors: the external conditions that make swallowing easier or harder.

what are the events in a normmal swallow...

apnea onset

oral bolus transport

hyoid excersion

maximum laryngeal closure

PES opening

maximum hyoid excursion

laryngeal opening

swallowing inspiration

apnea onset

hyoid return

functional components of normal swallow mech: oral cavity

Bolus intake and containment

- lips: closure around spoon, cup, straw & closure to contain the bolus

- cheeks: tension assists with lip closure

- velum: elevates to allow creation of negative pressure of negative pressure for suction (straw or bottle)

Bolus preparation

- teeth: mastication

- tongue: during force for movement during mastication and propulsion of the bolus

- gingival and buccal gutters: channel the bolus

- soft palate: contacts the tongue to keep the bolus contained in the oral cavity

what creates negative pressure?

the velum elevates to allow the creation of negative pressure for suction

functional components of normal swallow mech: oropharynx

oropharyngeal propulsion pump

includes: soft palate, lateral pharyngeal walls, and the base of the tongue

velopharyngeal function (oropharynx)

velopharyngeal function

- the soft palate elevates as the tongue propels

- tonngue elevation is necessary for propulsion

what is necessary for tongue propulsion

tongue elevation

functional components of normal swallow mech: hyropharynx

muscular propulsion

- includes pharyngeal constrictors and pyriform sinuses

larynx

- closure of glottis, ventricular folds, epiglottis

- pharyngeal squeeze

- hyoid elevation

functional components of normal swallow mech: esophagus

1. upper esophageal sphincter opening

2. primary peristalic wave

3. secondary peristalic wave

what are the phases of a normal swallow

1. oral prep (voluntary)

2. oral (voluntary)

3. pharyngeal (involuntary)

4. esophageal (involuntary)

what does the oral prep phase include (voluntary)

this phase is focused on tasting, chewing and manipulating food or liquid to prepare it for swallowing

- lip seal: the lips close tightly (obicularis oris muscle) to prevent food or liquid from leaking out of the mouth

- mastication: the jaw moves in a rotary motion to chew solid foods, while the cheeks (buccinator muscle) tense to keep food from pocketing between the teeth and gums

- bolus formulation: saliva mixes w/food to break it down chemically and lubricate. The tongue manipulates the food, gathing it into a single, chesive call known as the bolus.

- base of tongue control: the back of the tongue elevates against the soft palate (velum) to keep the food in the mouth and prevent it from spilling backward into the airway before you are ready

what is involved in the oral prep phase

lip seal

mastication (chewing)

bolus formulaton (mixes with saliva)

base of tongue control (prevent spillage)

what does the oral transit phase include (voluntary)

this phase takes less than 1 - 1.5 seconds and focuses on moving the food to the back of the throat

- anterior to posterior stripping: the tip and side of the tongue anchor firmly against the hard palate (roof of mouth). The middle and back of the tongue then perform a rolling, stripping motion.

- propulsion: this tongue movement sequeezes the bolus backwards along the palate towards the pharynx (throat)

- trigger point: oral phase offically ends, and the pharyngeal swallow reflex is triggered, when the leading edge of the bolus passes the anterior faucial arches (or where your lower jaw crosses the base of the tongue)

what is involved in the oral transit phase

anterior to posterior stripping

propulsion (sequeeze bolus backwards)

trigger point (oral phase offically ends- passess anterior faucial arches)

what does the pharyngeal phase include (involuntary)

this is the most critical phase, lasting 1 second or less, where the airway is sealed off and the food is guided in the esophagus

- velopharyngeal closure: soft palate elevates and moves backward to seal off the nasal cavity, preventing food or liquids from entering the nose (nasal regurgitation)

- hyolaryngeal elevation: the hyoid bone and larynx pull dramatically upward and forward. This movement tucks the larynx safely under the tongue base and helps pull open the top of the esophagus

- airway protection: 3 structural layers close to protect the lungs

-- the vocal folds close tightly together

-- the flase vocal folds constrict

-- the epiglottis flips down like a tradoor over laryngeal opening

- pharyngeal peristalis: mucles of the throat (pharyngeal constrictors) sequeeze sequentially from top to bottom, stripping the bolus downward

- UES opening: the upper esophageal sphincter (UES), which is normally kept tightly closed to prevent air from entering the stomach, relaxes and pulls open to allow the bolus to pass

what is the most critical phase in swallowing

pharyngeal phase

what is involved in the pharyngeal phase (involuntary)

velopharyngeal closure (sealing off nasal cavity)

hyolaryngeal elevation (hyoid and larynx elevate)

airway protection (false and true VF close, and epiglottis flips downward)

pharyngeal peristalis

UES opening (normally is tight, but relaxes and pulls open to allow bolus to pass)

what is the esophageal phase (last phase- involuntary)

this phase takes anywhere from 8-20 seconds, moving the food from the neck down to the stomach

- peristalic wave: once bolus enters the esophagus, the UES snaps shut to prevent the food from coming back up. A slow wave like muscular contraction (peristalis) pushes the bolus down through the tube

- LES relaxation: as the bolus reaches the bottom of the esophagus, the lower esophageal sphincter (LES) relaxes

- entry into stomach: bolus passes through LES and enters stomach, completing normal swallow cycle

what is involved in esophageal phase

peristalic wave (UES snaps shut- peristalis occurs pushes bolus down)

LES relaxation (bolus reaches bottom of esophagus and LES relaxes)

entry into stomach (bolus passes through LES and enters stomach)

review of stages of swallowing

Oral prep

- lip seal

- mastication

- bolus forms with saliva

- tongue base elevates to soft palate

Oral transit

- anterior-posterior stripping

- bolus propelled to pharynx

- trigger point: bolus passes anterior faucial arches

Pharyngeal

- velopharyngeal closure

- hyrolaryngeal elevation

- airway protection (VF closure to false VF to epiglottis)

- pharyngeal peristalis

- UES opening

Esophageal

- primary peristalic wave

- LES relaxes

- bolus enters stomach

what are the muscles of mastication?

temporalis and masseter (CN V)

(also lateral and medial pterygoid)

masster muscle

elevates the mandible, closes the mouth

if damaged: weak jaw closure (difficulty biting and grinding food; reduced bolus formulation) (CN V)

temporalis muscle

retracts and elevates the mandible if damaged, inability to retract jaw (poor alignment of teeth, inefficient chewing, fatigue during mastication)

(CN V )

lateral pterygoid

depresses and moves mandible laterally

if damaged: jaw deviation toward the affected side, limited lateral movement)

medial pterygoid

elevates and protrudes mandible forward

if damaged: weak protrusion and reduced grinding motion

what happens when CN V is impaired

oral prep phase dysfunction!!!

- reduced rotery motion (causing food pocketing in cheeks)

- loss of sensory feedback (decreased awareness of food texture)

- oral prep phase deficits: prolonged chewing and drooling

- secondary swallowing issues: delayed swallow trigger and increased aspiration risk

what is the role of the suprahyoid muscles

in general is to elevate the hyoid, possibly depress the mandible (CN V and VII)

what are the suprahyoid muscles

mylohyoid

stylohyoid

digastric

mylohyoid muscle (suprahyoid muscle)

elevates hyoid bone, aids in depressing mandible (CN V)

stlohyoid muscle (suprahyoid muscle)

moves hyoid bone posteriorly, evelates hyoid bone (CN VII)

digastric (suprahyoid bone)

elevates hyoid bone, depresses mandible (CN V and CN VII)

what is the job of the infrahyoid muscles

lower the hyoid bone, spinal nerve innervation (exception: the thyrohyoid, specifically aids in elevating the thyroid during pharyngeal phase CN XII)

infrahyoid muscles

omohyoid

sternohyoid

sternothryoid

thyrohyoid

omohyoid (infrahyoid muscles)

lowers hyoid bone, spinal nerves C 1-3

sternohyoid (infrahyoid muscles)

aids in lowering hyoid bone, spinal nerves C 1-3

sternothyroid (infrahyoid muscles)

lowers thyroid cartilage, spinal nerves C-3

thyrohyoid (infrahyoid muscles)

lowers hyoid bone BUT elevates thyroid cartilage during pharyngeal phase, spinal nerves C-3, CN XII

What are the extrinsic muscles responsible for

extrinsic muscles in general serve to elevate, depress, and retract the tongue (CN XII)

Exception: palatoglossus specifically also helps lower the soft palate (CN X)

what are the extrinsic muscles

genioglossus

hyoglossus

styloglossus

palatoglossus

genioglossus (extrinsic muscle of tongue)

depresses tongue/ moves tongue anteriorly (CN XII)

hyoglossus (extrinsic muscle of tongue)

depresses tongue/decreases sides of tongue (CN XII)

styloglossus (extrinsic muscle of tongue)

elevates tongue/retracts tongue (CN XII)

palatoglossus (extrinsic muscle of tongue)

elevates posterior tongue and lowers soft palate (CN X)

what are the intrinsic muscles of the tongue responsible for

intrinsic muscles of the shape the tongue

Exception: geniohyoid specifically elevates the hyoid and tongue, spinal nerve C1)

what are the intrinsic muscles of the tongue

transverse

vertical

longitudinal

geniohyoid

transverse (intrinsic muscle of the tongue)

elongates and narrows the tongue (CN XII)

vertical (intrinsic muscle of the tongue)

flattens and widens the tongue (CN XII)

longitudinal (intrinsic muscle of the tongue)

elevates tip of tongue, depresses apex and sides of tongue (CN XII)

what are the constrictor muscles (CN X)

superior constrictor

middle constrictor

inferior constrictor

superior constrictor (CN X)

constricts upper pharynx

Middle Constrictor (CN X)

constricts upper pharynx

Inferior Constrictor (CN X)

part of the esophageal sphincter (UES) constricts (CN X)

what are the sphincters?

velopharyngeal

laryngeal

UES

velopharyngeal sphincter

-Closure prevents leakage into nasopharynx

-Lack of closure or poor timing of the closure leads to:

-- diminished ability to generate pressure to propel the bolus

-- leakage of the bolus or air into nasopharynx

-- dysfunction: nasal regurgitation, reduced propulsion

laryngeal sphincter

closure happens in sequential fashion

- true vocal folds close

- false vocal folds close

- arytenoid approximation to the epiglottis, causing the epiglottis to close over the laryngeal vestibule

Dysfunction: penetration, aspiration, decreased ability to generate adequate hyopharyngeal pressures to propel the bolus through pharyngoesophageal segment into esophagus

Upper Esphageal Sphincter (UES)

cricopharyngeus muscle

- tonically contracted to prevent air from entering the gastrointestinal tract

- UES relaxes during pharyngeal peristalic action

- contracts after relaxation and passage of the bolus

DAMAGE: residue, aspiration, impaired opening

lower esophageal sphincter (LES)

relaxes to permit bolus entry into stomach

contracts to prevent gastroesophageal reflex in its resting state