335 9.1 Deglutition and Mastication

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shanamd2010
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335 9.1 Deglutition and Mastication
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2012-03-26 11:56:04
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deglutition mastication
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deglutition and mastication
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  1. mastication
    process of preparing food for swallowing
  2. masication includes
    • moving unchewed food onto grinding surface of the teeth
    • chewing the food
    • mixing it with saliva in preparation for swallowing
  3. deglutition
    the process of swallowing
  4. deglutition characteristics
    • a basic biological function
    • occurs hundreds of times a day
    • present in utero 10-11 wekks, first trimester
  5. disorders of swallowing
    dysphagia
  6. four stages of swallowing
    • voluntary: oral preparatory stage and oral stage
    • involuntary: pharyngeal and esophageal
  7. oral preparatory stage
    • food is prepared for swallowing
    • is voluntary yet is done automatically without conscious effort
  8. labial seal
    to keep food in the mouth (orbicularis oris)
  9. bolus
    • mass of chewed food formed into a all to be swallowed
    • Salivary glands secrete saliva into oral cavity to help form mass of food into bolus
    • X, XI keeping bolus in mouth
  10. oral preparatory stage functions
    • bolus is being formed by chewing (V Trigeminal - mandibular muscles)
    • Buccal tension (Buccinator and Risorius)
    • VII keeps food from passing into spaces btw the teeth and cheeks
    • velum is depressed
    • airway open for respiration
    • X larynx abducted (posterior cricoarytenoid muscles)
  11. oral stage
    • begins when bolus has been chewed and is ready to be swallowed or when liquid is on tongue
    • lingual peristalsis then begins to push bolus to back of mouth (XII hypoglossal)
    • abterior tongue elevates to hard palate
    • central tongue groove contains bolus and margins (sides) of tongue are down
    • bolus squeezed to back toward the faucial pillars
    • contact with faucial arches triggers the swallow reflex (IX)
  12. oral stage time
    • total transit time to move bolus to back of mouth is < 1 sec
    • this is known as oral transit time
  13. pharyngeal stage begins
    when swallowing become reflexive (faucial pillars)
  14. pharyngeal stage
    • complex sequence of reflexes
    • begins when reflex is triggered
    • total transit time from faucial arches to esophagus is < 1 sec
    • four movements occur simultaneuosly
  15. movements of the pharyngeal stage
    • elevation and retraction of velum (prevents nasal regurgitation) X, XI - levator veli palatini
    • oral and nasal cavities are ow separate
    • food now entering pharynx
    • airway must be protected to prevent aspiration
    • pharyngeal peristalsis - muscles the squeeze or help with movement of the bolus - superior, middle, and inferior pharyngeal constrictors contrat the bolus down the pharynx
    • elevation and closure of the larynx
    • relaxation of upper esophageal shpincter (cricopharyngeus muscle to allow food into the esophagus)
  16. upper esophageal sphincter
    • cricopharyngeus muscle
    • nrmally closed/sealed shut so now must relax/open
  17. 4 levels of closure of the vocal folds/larynx
    • 1. true vocal folds (ones used to create voice)
    • 2. false vocal folds (ventricular vocal folds - not used for speech)
    • 3. aryepiglottis folds
    • 4. epiglottis
    • these always close in this order - from bottom to top
  18. esophageal stage
    • perstalsis and gravity
    • total transit time from top of esophagus to stomach is 8 - 20 seconds
    • this is the stage that SLPs do not deal with
  19. modified barium swallow study
    aka
    what is it
    • videofluoroscopic study
    • diagnostic x-ray to examine oral, oral prepatpry and pharyngeal stages of the swallow
  20. modified barium swalllow study
    uses
    who is present
    • uses different consistencies ofliquids and solid mixed with barium (radio-opaque substance)
    • SLP, radiologist and doctor are present at time of x-ray
  21. will everyone with dysphagia have a modified barium study done?
    no, many time the SLP will do a bed side evaluation, which is were they watch the throat and feel and see the person's reaction to different foods.
  22. most ppl with dysphagia have a hard time with
    • thin liquids (water, coffee, milk, etc.)
    • a powder can be used to thicken these into a different consistency (4 consistencies)
  23. ppl who refuse the modified diet must
    sign a waiver
  24. deficits of the oral prepatory stage
    • loss of sensation and awareness
    • weak buccal musculature leads to pocketing of food in lateral and anterior sulci
    • weak lingual muscles lead to poor mixture of saliva with food
    • lingual Istasis = food remaining on tongue following the swallow
    • difficulty pressing bolus to the hard palate
    • food escaping into pharynx prior ot the pharyngeal swallow reflex if the velum is not dow/depressed
  25. what is our biggest concern for individuals with dysphagia
    aspiration pneumonia
  26. deficits of the oral stage
    • motor and sensory dysfunction
    • significant increase in oral transit time
    • food may remain on tongue and/or hard palate following transit
    • difficulty initiating a swallow
  27. what treatment is used for the deficits of the oral stage
    • thermal stimulation
    • effectiveness is debated
  28. deficcits of the pharyngeal stage
    • slow velar leads to nasal regurgitation
    • reduced function of the pharyngeal constrictors leads to a slowed pharyngeal transit time of the bolus
    • residue left in the valleculae and pyriform sinuses which can lead to aspiration
    • if hyoid bone and larynx do not elevate, there is a loss of airway protection and an increase risk of aspiration
  29. valleculae location
    in front of epiglottis and behind tongue
  30. pyriform sinuses location
    two grooves on either side of the cricopharyngeus muscle

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