CDS 555 Anatomy and Physiology

What are the stages of a swallow?

Oral (both oral preparatory and oral transit), pharyngeal, and esophageal

What is AP transit?

Oral transit; moving bolus to the back of tongue

What cranial nerves are involved in the oral stage?

Trigeminal V, Facial VII, Hypoglossal XII

What is the anterior sulcus?

The space between lips and teeth

What are the lateral sulci?

The space between cheeks and teeth

What can occur at the anterior and lateral sulci?

Pocketing of food

What does contact between the back of tongue and the soft palate prevent?

Premature spillage

What is the primary manipulator of the bolus?

Tongue

What are the 3 major salivary glands on each side?

Parotid, submandibular, and sublingual

What are the functions of saliva?

Lubrication, protection, digestion, and communication

Which part of the tongue is under voluntary neural control?

Oral portion

Which part of the tongue is under involuntary neural control?

The pharyngeal portion (base of tongue)

What are the steps of the oral phase?

Food to mouth, containment, bolus preparation, bolus transit

What is BOT?

Base of tongue

What are the intrinsic muscles of the tongue?

Transverse, vertical, longitudinal, and geniohyoid

What are the extrinsic muscles of the tongue?

Genioglossus, hyoglossus, styloglossus, and palatoglossus

What are the four muscles of mastication?

Masseter, temporalis, lateral pterygoid, and medial pterygoid

What do the muscles of mastication do?

Control the mandible

What is involved in bolus preparation?

Teeth, tongue, saliva, and soft palate

When is the pharyngeal stage triggered?

After A-P transit

What does the pharyngeal phase initiate?

The swallow reflex

If the hyoid elevates, the larynx will move upward and forward. What is this called?

Hyolaryngeal excursion

What is hyolaryngeal excursion?

The larynx moving upward and forward when the hyoid elevates

What do suprahyoid muscles do?

Elevate the hyoid bone

What do infrahyoid muscles do?

Lower/anchor the hyoid bone

What are the 3 sections of the pharynx?

Nasopharynx, oropharynx, and laryngopharynx

What are the muscles of the pharynx?

Salpingopharyngeus, stylopharyngeus, and palatopharyngeus

What is the primary role of the pharyngeal muscles?

Elevate the pharynx and larynx to increase passageway to esophagus

What do the pharyngeal constrictors do?

Form the posterior and lateral pharyngeal walls involved in swallowing

What is the function of the pharyngeal constrictors?

Constrict pharynx to facilitate bolus movement

What is pharyngeal transit time (PTT)?

Time it take the bolus to travel through pharynx (BOT → UES)

What are the laryngeal cartilages?

Cuneiforms (2), thyroid (1), epiglottis (1), cricoid (1), arytenoids (2), and corniculates (2)

What are the valleculae?

Wedge-shaped spaces formed by the base of tongue and epiglottis

What is vallecular pooling?

Food/liquid in valleculae BEFORE swallow

What is vallecular residue?

Food/liquid in valleculae AFTER swallow

What are the pyriform sinuses/recesses?

Cup-shaped spaces formed by the fibers of the inferior pharyngeal constrictors as they attach to the sides of the thyroid cartilage anteriorly

What is pooling in pyriforms?

Food/liquid in pyriform sinuses BEFORE swallow

What is residue in pyriforms?

Food/liquid in pyriform sinuses AFTER swallow

What are the intrinsic muscles of the larynx?

lateral cricoarytenoid muscle, transverse arytenoid muscle, posterior cricoarytenoid muscle, transverse arytenoid muscle, oblique arytenoid muscle, aryepiglottic muscle, cricothyroid muscle, thyroarytenoid muscle, vocalis muscle

What are the 3 levels of protection in the larynx?

True vocal folds, false vocal folds, and base of epiglottis

What is the physiology of the pharyngeal stage?

1. Velum elevates to prevent material from entering nasal cavity

2. Tongue base retracts to posterior pharyngeal wall (PPW) to create pressure

3. Hyoid elevation / epiglottis closes and lifting of larynx

4. Larynx closes at 3 levels to protect airway

5. Hyolaryngeal excursion

6. UES opens

How does food/liquid get propelled into the stomach?

Peristalsis

What are the sphincters involved in swallow?

Velopharyngeal sphincter, laryngeal sphincter, upper esophageal sphincter, and lower esophageal sphincter

What is the purpose of sphincters?

To prevent spillage

What is the relationship between bolus size and duration of swallow apnea?

The larger the bolus size, the longer the duration of
swallow apnea

Why may an apnea event vary?

State of the patient, the bolus, and the age of the patient

What is cranial nerve V?

Trigeminal nerve

What is cranial nerve VII?

Facial

What is cranial nerve IX?

Glossopharyngeal

What is cranial nerve X?

Vagus

What is cranial nerve XI?

Spinal accessory

What is cranial nerve XII?

Hypoglossal

What are sensory responsibilities of cranial nerve V (trigeminal)?

Sensation to face (touch, pain, temp.) and sensation to anterior 2/3 tongue

What are motor responsibilities of cranial nerve V (trigeminal)?

Mastication, innervates floor muscles of mouth, aids in velopharyngeal closure

What are sensory responsibilities of cranial nerve VII (facial)?

Taste anterior 2/3 tongue

What are motor responsibilities of cranial nerve VII (facial)?

Facial muscles for swallowing, muscles of facial expression, salivary glands, elevate and retract hyoid, raises larynx for airway protection

What are sensory responsibilities of cranial nerve IX (glossopharyngeal)?

Taste posterior 1/3 of tongue, general sensation posterior 1/3 of tongue, sensation to mucous membranes of soft palate, fauces, valleculae, and pharynx

What are motor responsibilities of cranial nerve IX (glossopharyngeal)?

Contributes to function of middle pharyngeal constriction, elevation pharynx (stylopharyngeus) and larynx and closes pharynx for VP closure, contributes to innervation of UES

What are sensory responsibilities of cranial nerve X (vagus)?

Innervates hard palate for taste, taste receptors in pharynx, epiglottis, and mucosa of valleculae

What are motor responsibilities of cranial nerve X (vagus)?

Palatal muscles, pharyngeal reflexes and constrictors, intrinsic laryngeal muscles, main innervation cricopharyngeus muscles are both smooth and striated esophageal musculature, esophageal motility

What are motor responsibilities of cranial nerve XI (spinal accessory)?

Motor functions to larynx chest, shoulder

What are motor responsibilities of cranial nerve XII (hypoglossal)?

Intrinsic and extrinsic tongue muscles