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Name the 2nd sensory branch of the trigeminal nerve. Describe its receptive field(s) and swallowing functions
- Maxillary branch
- Superior alveolus, hard and soft palate
- oral containment, preparation and containment, tactile sensation, stereognosis, bolus manipulation
Name the 3rd sensory branch of the trigeminal nerve, describe its receptive field(s) and swallowing functions.
- Mandibular branch
- Anterior ⅔ of the tongue, inferior alveolus
- Tactile sensation, oral containment, stereognosis, preparation and containment, manipulation
Name the sensory receptive field of the VII facial nerve and describe its role in swallowing.
- Anterior ⅔ of tongue
- Motivation to eat and drink, taste
Name the sensory receptive field(s) of the XI glossopharyngeal nerve and describe its swallowing function
- Posterior 1/3rd of the tongue: tactile sensation, taste, motivation to eat and drink, oral bolus containment, stereognosis
- faucial arches and oropharynx: tactile sensation, initiation of pharyngeal swallow
Describe the sensory SLN receptive field(s) and its role in swallowing
- Tongue base: tactile sensation base of tongue, pharyngeal swallow initiation
- Supraglottic larynx (valleculae, epiglottis, aryepiglottic folds): tactile sensation, airway protection, initiation of laryngeal closure
- Pyriform sinuses: Tactile sensation, airway protection
- True and ventricular folds: Tactile sensation, airway protection
- Posterior pharyngeal wall: tactile sensation, pharyngeal clearance
Describe the receptive field(s) of the RLN and its role in swallowing functions.
- Subglottic regions (trachea, bronchi)
- Tactile sensation, airway clearance
What muscle does the motor portion of V3 innervate? What are the swallowing functions?
- (Mandibular branch)
- Mylohyoid, anterior belly of the digastric: Anterior hyolaryngeal excursion
- Tensor veli palatini, pterygoid; temporalis; masseter: Prevention of nasal regurgitation (VP valving), positive pressure generation
- Pterygoid, temporalis, masseter: Mastication
What muscles does the XII Facial nerve innervate? what are the swallowing functions?
- Obicularis oris; buccinators: Oral bolus containment and mastication
- Posterior belly of digastric, stylohyoid: Laryngeal elevation
What muscles does the X Vagus nerve innervate? What are the swallowing functions?
- Palatoglossus: Oral bolus containment
- Palatopharyngeus: Oral bolus containment; pharyngeal shortening
- Levator veli palatini: Prevention of nasal regurgitation (VP valving), positive pressure generation
- Pharyngeal constrictors (superior, middle, inferior): Pharyngeal contraction
- Intrinsic laryngeal: Airway closure
- cricopharyngeus: PES relaxation and opening
What muscles does the XII hypoglossal nerve innervate? Swallowing functions?
- Extrinsic Lingual:
- Genioglossus: Oral bolus manipulation, formation, containment, transport, positive pressure generation
- Hyoglossus: Hyoid elevation
- Styloglossus: Tongue base retraction
- Intrinsic lingual: Superior and inferior longitudinal, Vertical, Horizontal: Tongue shaping, oral bolus manipulation, formation, containment, transport
What muscles do C1-C2 of XII hypoglossal ansa cervicalis nerve innervate? Swallowing function?
- Geniohyoid: Anterior hyolaryngeal excursion
- Thyrohyoid: Laryngeal elevation
Name some consequences of dysphagia.
- Quality of life (health, psychological, financial)
- Caregiver burden
- Consequences: Aspiration, aspiration pneumonia, dehydration, malnutrition, weight loss
Name some etiologies of dysphagia.
- Presbyphagia (natural aging)
- Sarcopenia (age related skeletal muscle deterioration)
- Neurological disease
- Head injury
- degenerative disease
- systemic disease
Briefly describe the history of dysphagia treatment
- 1500 BC: Rectal feeding
- 1872: Nasoesophageal tubes
- 1976: Symptomatic tx
- 1980: Instrumentation
Briefly describe the SLP role in swallowing disorders
- Feeding/swallowing evals
- Instrumental assessments for structure/function of swallowing
- Define abnormal swallowing A&P/dx swallow disorders
- ID other disorders, refer
- Recommendations for management
- Treatment, document progress, determine appropriate discharge criteria, teach/counsel, educate, advocate
Difference between feeding and swallowing?
- Any disturbance in normal transfer of food from oral cavity through pharynx and esophagus to the stomach.
- Feeding: Food to mouth; manipulating food in mouth and chewing, collecting bolus, and initiating lingual thrust
- Swallowing: Manipulation of food in mouth, collecting bolus, initiating swallow gesture, transit of bolus to esophagus to stomach
10 Principles of Neuroplasticity and Swallowing
- *Swallowing is somewhat behavioral (cortical control)
- Use it or lose it
- Use it and improve it
Name the 4 stages of swallowing.
Oral prep, oral, pharyngeal, esophageal
Name the 17 MBSImP components.
Oral has 6
Pharyngeal has 10
Esophageal has 1
- Lip closure
- Bolus hold
- Bolus prep/mastication
- Bolus transport/ lingual motion
- Oral residue
- Initiation of pharyngeal swallow
- Velum elevation
- Laryngeal elevation
- Anterior hyoid excursion
- Epiglottic movement
- Laryngeal vestibular closure
- Pharyngeal stripping wave
- Pharyngeal contraction
- PES opening
- Tongue base retraction
- Pharyngeal residue
- Esophageal clearance
Explain the processes in the oral prep stage.
What cranial nerve, and what branch specifically, is associated with this stage?
- Voluntary mastication/preparation into a bolus
- Labial seal
- Buccal tension closes lateral sulci
- Lateral and rotary tongue and mandible movement
- Food mixed with saliva
- Bolus formation
- BOT high, larynx/pharynx open/nasal breathing may continue
- CN V; V3 (mandibular)
The normal swallow in the oral domain is voluntary from the tip of the tongue to ___________. It moves the bolus posterior to top of ______ and generates ____ pressure as tongue rolls back along hard and soft palate. there are integrated movements, _______ and ____ ____.
- Anterior faucial pillar
- mastication, bolus prep
Name the 6 Oral Domain components.
- Lip closure
- tongue control during bolus hold
- bolus prep/mastication
- bolus transport/lingual motion
- oral residue
- initiator of pharyngeal swallow
Describe oral anatomy. (work from outside in)
- Lips (component #1): orbicularis oris, risorius, anterior sulcus, lateral sulcus
- 32 Teeth
- Cheek and face: (CN VII), buccinator
- Mandible (jaw)
- Hard palate (Maxilla)
- Parotid gland
- Submaxillary and sublingual saliva glands (parotid, submaxillary, sublingual)
- Tongue: control during bolus hold
Oral domain-Creation of pressure. How?
Describe intrinsic/extrinsic tongue muscles and functions.
- Tongue applies force to tail of bolus lingual propulsion
- Intrinsic: Tongue shaping (shorten/tip up and down)
- Extrinsic: genioglossus, styloglossus, hyoglossus, palatoglossus--protrusion, retraction, elevation, depression
What occurs during oral component #3 (bolus preparation and mastication)?
Rotary motion, mixing of saliva with bolus, lateralization of bolus
Oral Anatomy-Faucial pillars
- Anterior: Palatoglossus-soft palate to sides of posterior tongue; pull palate down or elevate sides or back of tongue
- Posterior: palatopharyngeus-soft palate to lateral walls of pharynx; pulls soft palate down, elevate larynx, pulls arches together, active in gag reflex
What do you look for in oral component #5 (oral residue)?
What does residue on palate mean? Middle of tongue?
- Amount, location (floor of mouth, palate, tongue, lateral sulci)
- Tongue weakness; lack of saliva, sensation, pressure, awareness
What is the transition from oral to pharyngeal stages?
- No clear delineation
- Initiation of swallow response (not reflex) when head of bolus reaches angle of ramus; can depend on consistency (alter space viscosity, position for swallowing)
What are the 3 levels of protection?
- Epiglottic movement
- True vocal folds
- Vestibular closure
Name the 10 pharyngeal components and their functions.
- Soft palate elevation: close nasal cavity & seal pressure
- Laryngeal elevation
- Anterior hyoid ecursion
- Epiglottic movement (inversion to cover airway entrance)
- Laryngeal vestibular closure (space above vocal folds between epiglottis and aryepiglottic folds)
- Pharyngeal stripping wave (constricting wave from superior to inferior, squeezes food)
- Pharyngeal contraction (AP View only)
- PES opening (sphincter opens to allow bolus to move through)
- Tongue base retraction
- Pharyngeal residue (not movement, but look for residue)
Why might there be residue in valleculae?
- Lack of pressure, pharyngeal weakness
- To redirect bolus flow, turn head to side of bolus
The pharyngeal domain begins when swallow trigger is initiated. ____ receptors are stimulated. Messages are sent to the cortex and brainstem, more specifically the ____ ____ ___ in lower brainstem and medulla. Then the information is decoded, stimulus identified, then sent to ____ ____, where the ____ swallow motor pattern is initiated. You must have ____ input to swallow.
- Central pattern
- Nucleus ambiguous
Describe the pharyngeal anatomy.
- Hyolaryngeal complex
- Vallecular space
- Pharyngeal constrictors
- PE segment
- Pyriform sinuses
Pharyngeal component #7- Soft palate elevation
What muscles are responsible for:
Velar elevation: Vp closure and Vp depression?
- Closure: tensor veli palatini, levator veli palatini
- Depression: Palatoglossus (anterior faucial), palatopharyngeus (posterior faucial), muscularis uvulus
- CNV3, CNX, pharyngeal branch
- CNIX, general sensory, taste
Hyolaryngeal excursion (protection)
_____ and ____ movement tucks the larynx up and under the mandible to close the airway entrance. Assists in ____ opening. Anterior movement about width of one vertebrae.
What might superior only excursion indicate?
- Anterior, superior
- Poor CP movement (bolus wills it on performs)
Floats under the tongue and above the larynx at roughly the ___ cervical vertebra. Held by a large group of muscles. Supports the ____ __ ____ and ____. ____ is suspended from the hyoid.
- Base of tongue
Component #8: Laryngeal elevation
Helps bolus move around the airway and open the UES. Generates ___ pressure to propel bolus downward.
Mechanics of elevation
Anterior sling: Submental: mylohyoid, geniohyoid, ABD, contribution of PBD and stylohyoid plus thyrohyoid
Contribution of posterior sling: Anterior sling, long pharyngeal muscles (stylopharyngeus, palatopharyngeus, salpingopharyngeus)
Anterior Hyoid Excursion
- Aids in CP opening
- Laryngeal elevation in ½ sec
- Elevation sustained ½-⅓ sec
Anterior attachment (root): ____ cartilage
Posterior attachment: ______ ______
Acted upon by hyolaryngeal excursion and ____ of ____.
Moves to _____ position
At full retroversion, arytenoids actually contact epiglottis.
- Free edge
- pressure of bolus
Space where BOT meets base of _____.
Divided into right and left by glossoepiglottic fold.
Laryngeal vestibular closure
Laryngeal vestibule: Area just below epiglottis and ending at ___.
Laryngeal vestibular closure-height of swallow
Intrinsic laryngeal muscles approximate the ___ and ___
- false vocal folds
- arytenoid, epiglottis
Connect arytenoids to ____
Form rim around laryngeal vestibule
Help form lateral channels to protect airway.
False vocal cords
Form lower borders of laryngeal vestibule
Vocal fold ____
Names of muscles? (5)
- Ventricular folds
- Thyroarytenoids, cricothyroids, lateral cricoarytenoids, transverse arytenoid, oblique arytenoid
Component #12: Pharyngeal stripping wave
Can be trained
Progressive contraction from nasopharynx through PE segment
Pharyngeal constrictors: superior, middle, inferior
Squeezing and shortening of pharynx
Pressure forces bolus toward esophagus
Component #13: Pharyngeal Contraction
___ view only
Cant be viewed with scope
Symmetrical shortening and contraction of pharynx
What do normal and abnormal look like?
Normal= straight, compressed, lateral walls that strip downAbnormal= Often seen in pulmonary patients who use accessory laryngeal muscles
Deepest part of pharynx
Space of either side of ___
Space formed by fibers of ___ constrictor attached to sides of ___ cartilage
PE segment opening (component #14)
Muscular relaxation & distention
Inferior fibers of inferior constrictor
Most ____ portion of longitudinal esophageal fibers
Located at 5th and 6th cervical vertebrae
Innervated by pharyngeal branches of vagus nerve
Traction forces pull open UES.
What may reduce PE opening?
- Poor HL elevation and anterior movement, bolus pressure
Component #15: Tongue base retraction
Genioglossus, hyoglossus, styloglossus
Component #16: Pharyngeal residue
Clinical sign of ____ impairment
Amount remaining after swallow
Complete clearance through no clearance
Reflexive passage of bolus through UES and down esophagus. Move bolus between ___ and esophagus.
3 stages moving down esophagus?
- 1. Momentum of bolus thanks to lingual and pharyngeal compression (pressure) 2. peristaltic action 3. gravity
Esophageal stage anatomy
Sphincters? How are the layers? How long does it take?
What does abnormal look like?
- CN X
- UES, LES
- upper ¼: striated; Distal ⅔- smooth; Middle ⅓- combination
- 8-20 seconds
- Extends through chest ventral to lungs around aorta and enters stomach through diaphragmatic hiatus
- Retrograde flow
Zones of pressure?
What are the 5 swallowing valves?
- High to low; generated via valves
- Lips, velum, airway closure, PES, LES