Dysphagia Final

What anatomic structures are involved in bolus preparation?

-teeth: mastication -tongue: driving force to propel bolus posteriorly -sulci: channel the bolus -soft palate: lowers and creates a seal to prevent early leaking/premature spillage

Signs and symptoms of dysphagia

1. inability to recognize food 2. difficulty placing food in the mouth 3. inability to control food or saliva in the mouth 4. coughing before, during, or after a swallow 5. frequent coughing toward the end or immediately following 6. recurring pneumonia 7. weight loss when no other reason can be defined 8. gurgly vocal quality or increase in secretions in the pharynx or chest after the swallow or towards the end of a meal 9. pt. complains of difficulty swallowing

Oral cavity structures

1. lips 2. teeth 3. hard palate 4. soft palate 5. uvula 6. mandible 7. floor of mouth 8. tongue 9. faucial arches

musculature of the floor of mouth

1. mylohyoid 2. geniohyoid 3. anterior belly of digastric

4 main anatomic structures of swallowing

1. oral cavity 2. pharynx 3. larynx 4. esophagus

the soft palate elevates and retracts to contribute to velopharyngeal closure by:

1. palatopharyngeus 2. levator palatal muscle 3. superior pharyngeal constrictor

the anterior wall of the pharynx is formed by:

1. pteryogoid plates/sphenoid bone 2. soft palate 3. base of tongue 4. mandible 5. hyoid bone 6. thyroid cartilage 7. cricoid cartilage

What are the 5 parts of the oral tongue?

1. tip 2. blade 3. front 4. center 5. back

Parts of the tongue (all)

1. tip 2. blade 3. front 4. center 5. back 6. base

Salivary glands produce what 2 types of fluid to make up saliva?

1. viscid-mucus-like 2. serious- watery

the hyoid bone is suspended by the ___________, ___________, and ________________

1. floor of the mouth muscles (mylohyoid, geniohyoid, anterior belly of digastric) 2. posterior digastric 3. stylohyoid

the rood of the mouth is formed by:

1. hard palate/maxilla 2. velum/soft plate 3. uvula

___________ sided infarcts have increased risk for aspiration compared to _________ sided stroke

L; R

what is the last level of airway protection before aspiration occurs?

TVC

Submandibular glands produce ____________

more serous than viscid fluid

Sublingual glands produce _____________

more viscid than serous fluid

sulci

natural cavities/spaces

What anatomic structures are involved in containment?

obicularis oris/lips: closure after bolus intake buccinators/cheeks: adequate tension to assist in lip closure

laryngeal vestibule

opening of the larynx; includes epiglottis, aryepiglottic folds, arytenoid cartilages

the soft palate pulls down and forward against the back of the tongue by the __________ which is within the anterior faucial arch

palatoglossus

3 main salivary glands:

parotid glands submandibular glands sublingual glands

respiration halts during what phase of swallowing?

pharyngeal phase

the anterior and lateral sulci are common locations for _____________

pocketing

posterior cricoarytenoid muscle

abducts/opens arytenoids/TVC for respiration

lateral cricoarytenoid and interarytenoid muscle

adducts/closes TVC

Definition of dysphagia

an impairment of emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to the stomach, resulting in failure to maintain nutrition/hydration, and posing a risk of choking and aspiration (aka difficulty moving food from mouth to stomach)

pneumonia

pulmonary infection

aspiration pneumonia

pulmonary infection resulting from acute or chronic aspiration of fluids, foods, secretions, stomach acid

respiration and swallowing are ____________

reciprocal

the larynx is the organ of _________, _________, and ____________

respiration, phonation, deglutition

Parotid glands produce ________________

serous fluid

pyriform sinuses

side pockets in lower pharynx above the UES; spaces formed between fibers of inferior constrictor and sides of thyroid cartilage

false vocal folds

soft tissue that projects from the sides of the larynx

laryngeal ventricle

space between the false vocal folds and true vocal folds

the posterior and lateral pharyngeal walls are formed by:

superior, medial, inferior constrictors

the laryngeal vestibule ends at ______________

the surface of the false vocal folds

the larynx is suspended from the hyoid bone by the _____________ and ____________

thyrohyoid ligament; thyrohyoid muscle

arytenoids

tilt anteriorly during swallowing, approximate for TVC closure

What is the pharyngeal tongue?

tongue base

epiglottis

top most structure of the laryngeal vestibule; rests against BOT; inverts to protect airway during the swallow

true vocal folds

vocalis and thyroarytenoid muscles

duration and characteristics of the swallow depend on the __________ and _________ of food as well as ________________ _____________

volume; type; voluntary control

valleculae

wedge-shaped space between the BOT and epiglottis

Lower esophageal sphincter

between esophagus and stomach; keeps food and secretions in stomach

Swallowing center is in the ___________

brainstem

Which type of stroke produces dysphagia more frequently?

brainstem stroke

the oral tongue end at the __________________

circumvallate papillae

the pharyngeal tongue begins at the ______________ and ends at the ________________

circumvallate papillae; hyoid bone

2 main functions of the oral cavity in swallowing:

containment bolus preparation

the oral tongue is under ________________ neural control by the ________________ nerve

cortical/voluntary; hypoglossal

most inferior structure of pharynx that prevents air from entering into the esophagus and reduces backflow into the pharynx

cricopharyngeal m/ UES/ PE segment

What muscle is responsible for tongue base retraction and the anterior bulging of the posterior pharyngeal wall at tongue base

glossopharyngeus muscle

nosocomial pneumonia

hospital-acquired pneumonia; results from bacterial infections acquired during the first 48-72 hours

the ____________ forms the foundation of the tongue

hyoid bone

Feeding disorder

impairment of the process of food transport outside the alimentary system

aphagia

inability to swallow anything

community-acquired pneumonia

infection of the lungs in people who haven't been hospitalized

2 layers of muscle of the esophagus:

inner circular and outer longitudinal

the pharyngeal tongue is under _____________ neural control by the ____________ nerve and can be placed under some degree of _______________ control by the ________________ nerve

involuntary; brainstem; voluntary; vagus

Complications of dysphagia

- aspiration pneumonia -malnutrition -dehydration - decreased quality of life

penetration

entry of food or liquid into the airway above the level of the TVC

aspiration

entry of food or liquid into the airway below the level of the TVC

backflow

food from the esophagus into the pharynx and/or from the pharynx into the nasal cavity

residue

food or liquid left behind in the mouth or pharynx after the swallow

aryepiglottic folds

form lateral walls of the laryngeal vestibule