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