MSD & Dysphagia Combined Set

Normal Swallow

The coordinated, safe movement of a bolus from mouth to stomach requiring intact anatomy, muscle timing, and sensory feedback.

Oral Preparatory Phase

Stage in which food or liquid is recognized, contained by a labial seal, and manipulated or masticated into a cohesive bolus.

Oral Phase

Stage where the tongue propels the bolus posteriorly with an anterior-to-posterior rolling motion toward the pharynx.

Pharyngeal Phase

Reflexive stage triggered as the bolus passes the anterior faucial arches, involving airway protection and bolus propulsion through the pharynx.

Labial Seal

Closure of the lips that prevents food or liquid from escaping the oral cavity during preparation and transit.

Tipper Position

Liquid bolus hold between tongue midline and hard palate with tongue tip on the anterior alveolar ridge.

Dipper Position

Liquid bolus hold on the floor of the mouth in front of the tongue prior to elevation for swallow.

Rotary Lateral Mandibular Movement

Chewing motion combining lateral and rotary jaw and tongue actions to grind solid food.

Premature Spillage

Escape of bolus into the pharynx before the swallow is triggered; normal during active chewing of solids but not during liquid or puree hold.

Bolus Viscosity

Thickness of a substance; as viscosity increases, maximum swallowable volume decreases and tongue pressure requirements rise.

Central Groove

Midline channel formed by tongue sides/tip anchoring to alveolar ridge, guiding bolus during oral transit.

Nucleus Tractus Solitarius (NTS)

Brainstem sensory center that decodes swallow stimuli and signals the nucleus ambiguus to initiate the motor pattern.

Velopharyngeal Port

Opening between nasopharynx and oropharynx; closes during swallow to prevent nasal regurgitation and build pressure.

Hyolaryngeal Elevation

Upward and forward movement of hyoid and larynx, aiding airway closure and UES opening.

Cricopharyngeal Sphincter

Muscular component of the UES that relaxes and is pulled open during swallowing to let the bolus enter the esophagus.

Upper Esophageal Sphincter (UES)

Junction between pharynx and esophagus that opens via CP muscle relaxation, hyolaryngeal traction, and bolus pressure.

Lower Esophageal Sphincter (LES)

Distal esophageal valve allowing bolus entry into stomach following esophageal peristalsis.

Laryngeal Vestibule

Space above the true vocal folds; entry of material here is penetration unless it drops below the folds.

True Vocal Folds

Paired laryngeal structures that adduct to seal the airway during swallow.

False Vocal Folds

Secondary laryngeal folds above the true folds that also approximate during swallowing for airway protection.

Epiglottis

Leaf-shaped cartilage that inverts from vertical to horizontal, deflecting the bolus away from the airway.

Esophageal Peristalsis

Sequential muscle contractions propelling the bolus through the esophagus.

Dysphagia

Impaired swallowing resulting from structural or functional deficits, leading to potential medical complications.

Sign (in dysphagia)

Objective evidence of swallowing disorder observable by examination, e.g., aspiration on VFSS or fever.

Symptom (in dysphagia)

Subjective complaint reported by patient, e.g., sensation of food sticking or effortful chewing.

Penetration

Entry of material into the laryngeal vestibule above the true vocal folds, with or without sensory response.

Aspiration

Passage of material below the true vocal folds into the airway before, during, or after the swallow.

Swallow Apraxia

Motor planning deficit causing absent or uncoordinated tongue movement despite bolus presence in the mouth.

Residue

Bolus material remaining in oral or pharyngeal cavities that should have cleared post-swallow.

Presbyphagia

Age-related, nonpathological changes in swallowing that reduce functional reserve and increase dysphagia susceptibility.

Masticatory Muscles

Muscle group (e.g., masseter, temporalis) responsible for chewing; strength declines with aging.

Pharyngeal Transit Time

Duration of bolus passage through the pharynx; typically increases in older adults.

Swallowing Apnea

Brief cessation of breathing during swallow; duration increases with aging.

Hypopharyngeal Intrabolus Pressure

Pressure within the bolus in the hypopharynx that can compensate for reduced UES opening in older adults.

UES Flexibility

Ability of the upper esophageal sphincter to distend; decreases with aging, contributing to prolonged opening times.

Polyphasic Extraneous Laryngeal Movements

Multiple, irregular laryngeal motions post-swallow more frequently observed in older adults.

Peristaltic Wave

Coordinated contraction sequence moving the bolus through the esophagus during the esophageal phase.

Bolus Subdivision

Process where the tongue separates a large intraoral bolus into smaller volumes for safer sequential swallows.

Neurogenic Dysphagia

Swallowing disorder caused by pathology within the nervous system (cortex, brainstem, cranial or peripheral nerves).

Respiratory-Related Dysphagia

Swallow impairment that arises from, or is worsened by, disorders of breathing or airway management.

Modified Barium Swallowing Impairment Profile (MBSImP)

Standardized tool for scoring physiologic components observed during a videofluoroscopic swallow study.

Neuroplasticity

The brain’s ability to reorganize neural connections after injury, experience, or learning.

Vallecular Residue

Bolus material remaining in the valleculae after the swallow, indicating inefficient tongue base retraction or elevation.

Pyriform Sinus Residue

Bolus material remaining in the pyriform sinuses after the swallow, usually from impaired hyolaryngeal elevation or UES opening.

Laryngeal Penetration

Entry of material into the laryngeal vestibule that does not pass below the true vocal folds.

Silent Aspiration

Aspiration that occurs without overt signs such as coughing or throat clearing.

Swallowing Apraxia

Difficulty initiating swallow in the absence of motor weakness or sensory loss, often from cortical damage.

Cerebrovascular Accident (Stroke)

Interruption of blood flow to the brain causing focal neurological deficits; a leading cause of neurogenic dysphagia.

Left-Hemisphere Stroke Dysphagia

Characterized by mild oral and pharyngeal delay and possible apraxia of swallow.

Right-Hemisphere Stroke Dysphagia

Similar physiologic defects as left-sided stroke but poorer outcomes due to attentional and judgment deficits.

Brainstem Stroke

Often produces the most severe dysphagia because the medullary swallowing centers and multiple cranial-nerve nuclei are affected.

Traumatic Brain Injury (TBI)

Acquired brain damage from external force; dysphagia prevalence can reach 93% and often relates to injury severity.

Glasgow Coma Scale (GCS)

Acute measure of consciousness used to grade TBI severity and predict dysphagia risk.

Rancho Los Amigos Scale (RLAS)

Behavioral rating of cognitive recovery after TBI; higher levels often parallel improved swallow function.

Functional Independence Measure (FIM)

Scale of disability assessing self-care and mobility; low scores correlate with dysphagia in TBI.

Dementia

Progressive decline in cognitive abilities; later stages commonly include swallowing and feeding difficulties.

Alzheimer’s Disease

Most common neurodegenerative dementia that can produce slow oral and pharyngeal swallow responses.

Frontotemporal Dementia

Dementia variant with prominent behavioral changes; exhibits distinct eating habit alterations versus Alzheimer’s.

Parkinson’s Disease

Basal ganglia degeneration causing bradykinesia, tremor, rigidity, and dysphagia marked by tongue pumping and delayed swallow.

Tongue Pumping

Repetitive anterior–posterior tongue rocking seen in Parkinson’s disease, prolonging oral transit.

Huntington’s Disease

Hereditary basal ganglia disorder with chorea and cognitive decline; dysphagia includes impaired bolus control and aspiration.

Amyotrophic Lateral Sclerosis (ALS)

Progressive degeneration of upper and lower motor neurons; eventually produces pervasive oral and pharyngeal dysphagia.

Myasthenia Gravis

Autoimmune neuromuscular disease causing fatigable skeletal-muscle weakness, including muscles of swallowing.

Sjögren’s Syndrome

Autoimmune disorder causing severe dryness of mucous membranes; patients often perceive greater swallow difficulty than instrumental findings reveal.

Guillain-Barré Syndrome

Acute polyneuropathy leading to rapid weakness and possible transient dysphagia during the demyelinating phase.

Collagen Vascular Disease

Autoimmune conditions (e.g., rheumatoid arthritis, lupus) that can affect connective tissues and swallowing structures.

Modified Barium Swallow Study (MBSS/VFSS)

Radiographic assessment that visualizes bolus flow and physiology across all swallow phases.

Respiratory Failure

Inadequate gas exchange (low oxygen and/or high carbon dioxide) requiring medical intervention and often airway support.

Ventilation

Mechanical movement of air in and out of the lungs via the pumping action of respiratory muscles and diaphragm.

Respiration (Gas Exchange)

Diffusion of oxygen and carbon dioxide across alveolar and cellular membranes.

Intubation

Placement of an endotracheal tube through the mouth into the trachea for airway protection and mechanical ventilation.

Post-Extubation Dysphagia

Swallow impairment following tube removal due to laryngeal edema, reduced sensation, and muscular atrophy.

Cuffed Tracheostomy Tube

Tube design with an inflatable balloon that seals the tracheal wall to prevent aspiration and deliver ventilator volumes accurately.

Passy-Muir Valve (PMV)

One-way speaking valve that redirects exhaled air through the vocal folds; restores subglottic pressure and can improve swallowing.

Chronic Obstructive Pulmonary Disease (COPD)

Progressive airflow limitation (emphysema and/or chronic bronchitis) leading to dyspnea and potential dysphagia.

Emphysema

Type of COPD where alveolar walls are destroyed, reducing elastic recoil and surface area for gas exchange.

Chronic Bronchitis

COPD variant characterized by chronic airway inflammation, thickened walls, and excessive mucus production.

Pneumonitis

Non-infectious inflammation of lung tissue due to irritants, allergens, radiation, or gastric contents.

Pneumonia

Infection plus inflammation of lung parenchyma caused by bacteria, viruses, or fungi; severity varies with host factors.

Aspiration Pneumonia

Infectious pneumonia resulting from inhalation of oropharyngeal or gastric material in patients with dysphagia.

Pulmonary Clearance Mechanism

Combined ciliary transport and alveolar macrophage activity that removes inhaled particles and secretions.

Muco-Ciliary Escalator

Ciliated epithelial transport that moves mucus and trapped debris upward toward the pharynx to be expelled or swallowed.

Alveolar Macrophage

Immune cells in alveoli that ingest and dispose of foreign particles via enzymatic degradation or lymphatic transport.

Cough Reflex

Protective mechanism (voluntary or involuntary) that clears the airway of irritants, secretions, or aspirated material. strength and presence inform aspiration risk.

Paroxysmal Cough

Sudden, uncontrollable bursts of coughing often due to pertussis or airway irritation.

Penetration-Aspiration Scale

Instrumental rating (PAS) that quantifies depth of airway invasion and patient response during swallow studies.

Stroke-Associated Pneumonia Predictors

Older age, greater stroke severity, COPD, dysphagia, coronary artery disease, and preadmission dependency raise pneumonia risk.

Costophrenic Angle

Radiographic junction of diaphragm and chest wall; blunting on CXR suggests pleural effusion.

Chest X-Ray Infiltrate

Area of increased opacity indicating fluid, infection, or consolidation within lung tissue.

White Blood Cell Count (WBC)

Laboratory measure (normal 4,500–11,000 cells/µL) that rises with infection such as pneumonia.

Arterial Blood Gas (ABG)

Test measuring PaO₂, PaCO₂, and pH to evaluate respiratory status; normal PaO₂ ≈ 85–100 mm Hg.

Oxygen Saturation (SpO₂)

Pulse oximetry estimate of hemoglobin saturation; values < 90 % often indicate hypoxemia.

Bronchodilator

Medication that relaxes airway smooth muscle, improving airflow in conditions like COPD and asthma.

Videofluoroscopic Swallow Study (VFSS)

Dynamic X-ray assessment of all phases of swallowing using barium-coated materials; gold standard for diagnosing aspiration.

Esophageal Phase

Final swallow stage where bolus passes through the esophagus to the stomach via peristalsis.

Pharyngeal Constrictors

Superior, middle, and inferior muscles that sequentially contract to propel the bolus toward the esophagus.

Deglutition

Scientific term for the act of swallowing.

Videofluoroscopic Swallow Study (VFSS)

A radiographic (fluoroscopic) examination of oral, pharyngeal, and often esophageal swallowing using barium-coated materials.

Upper Aerodigestive Mechanism

Combined structures of the upper airway and digestive tract involved in swallowing—nasal cavity, oral cavity, pharynx, larynx, and proximal esophagus.

Whiteout

Momentary loss of the endoscopic image during FEES at the height of the swallow when pharyngeal walls contract around the scope tip.