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PHYSIOLOGY OF
NORMAL DEGLUTITION
Anatomic Structures
Oral
Pharynx
Larynx
Esophagus
ORAL
Lips anteriorly
Teeth (24 Decidous, 32
Permenant)
Hard Palate
Soft Palate
Uvula
Mandible
Floor of Mouth
Tongue
Faucial Arches
Sulci
Natural Cavities/Spaces
Anterior Sulcus
Lateral Sulcus
Digastric
Hyoid
Forms foundation of the tongue
Larynx is supended from the
Hyoid Bone by the Thyrohyoid
Ligament and Thyrohyoid muscle
If the Hyoid elevates and moves
forward, the larynx will move
upward and forward unless it is
stabilized by other muscles
Tongue
Oral
Tip
Blade
Front
Center
Back
Oral Cavity
Hard palate/Maxilla
Velum/soft palate
Uvula
Velopharyngeal closure
muscle pulls
Palatopharyngeus
Levator palatal muscle
Superior Pharyngeal
constrictor
Salivary Glands
Viscid mucus like
2. Serous watery
1.
Pharyngeal Cavity
3 Pharyngeal constrictors
Superior
Medical
Inferior
Form posterior and lateral
pharyngeal walls
Pharyngeal cavity
Run laterally to attach to bony and soft tissue structures
located anteriorly: pterygoid plates, soft palate, BOT,
mandible, hyoid bone, thyroid and cricoid cartilages
Form the anterior wall of the pharynx
Inferior fibers of the superior constrictor attach to tongue
base/glossopharyngeus muscle. TBR and Anterior bulging
of the post pharyngeal wall at tongue base.
Pyriform Sinuses
Spaces formed between
fibers of inferior
constrictor and sides of
thyroid cartilage
Spaces end at
cricopharyngeal muscle
Cricopharyngeal muscle
Attach to cricoid lamina
Cricoid
lamina/cricopharyngeus
forms valve into
esophagus called the
cricopharyngeal region
CP
UES
PE segment
Esophagus
Collapsed muscular tube 23-25
cm long with sphincter at each
end UES/LES
Pharynx open vs. esophagus
closed
Sits behind trachea TE wall
(party wall)
LES (esophagus and stomach)
keep food and secretions in
2 layers of muscle:
inner circular and outer
longitudinal
Larynx
Base of tongue,
pharynx opens into
larynx
Topmost epiglottis
Attached into hyoid
bone by a ligament
Base attached to thyroid
notch
Larynx
Wedge-shaped space is the Valleculae
Open into larynx is Laryngeal Vestibule, which ends at
superior surface of false folds
Aryepiglottic folds form lateral walls
Arytenoids tilt anteriorly during swallowing, thought to be
form pull of the thyroarytenoid muscle fibers.
Tilt contributes to closure of airway
True cords form last level of airway protection
Larynx
3 levels of sphincter in
the larynx
1. Epiglottis and
aryepiglottic folds
2. Arytenoids
3. False Cords
Larynx
Larynx elevates
Pull anteriorly and
https://www.youtube.com/watch?v=YoDh_gHDvkk
https://www.youtube.com/watch?v=hdcTmpvDO0I
Physiology
1. Oral prep: food manipulated/masticated
2. Oral phase of swallow: tongue propels food
1. Oral Prep
Needs sensory recognition
Movement varies w/ viscosity
Requires open nasal airway and nasal
breathing
Tippers and Dippers
Tippers food held midline w/ tip elevated and contact w/ alveolar ridge
Dippers 20%, food held floor of mouth in front of the tongue
Tongue thrust tongue moves anteriorly w/ the bolus pushing food from
the mouth. Seen w/ adults with frontal lobe damage and children w/ CP.
Oral Prep
Soft palate is pulled down and forward, sealing off the oral
Oral Prep
Active chewing, soft palate not pulled down, thus
2. Oral Phase
Initiated when tongue begins post movement of bolus
Sides and tip of tongue anchor against the alvelor ridge.
Bolus propulsion
pharyngeal swallow
cranial IX, X, XI.
Impulses travel to the
swallow center in
brainstem. Motor IX
and X
Cortical recognition of
bolus critical to
initiation of oral phase
4. Pharyngeal Swallow
1. Velopharyngeal closure: elevation and retraction of the
velum and complete closure of the velopharyngeal portion
to prevent material from entering nasal cavity. Enables
build up of pressure in the pharynx.
Pharyngeal Swallow
2. Elevation and anterior movement of the hyoid and
larynx: Elevate and move anteriorly by the pull of the floor
of mouth muscles (anterior belly of digastric, myolohyoid,
geniohyoid, laryngeal elevator-thyrohyoid). Average
elevation 2 cm. Elevation contributes to closure of the
airway, forward movement contributes to opening of the
UES.
Pharyngeal Swallow
3. Closure of the Larynx: all 3 sphincters true folds,
laryngeal entrance (false folds, anterior tilt arytenoids,
thickening of epiglottic base) and epiglottis. Airway closed
1/3-2/3 second and 5 seconds w/ sequential cup drinking.
TVC close when larynx has elevated approx 50% of max
elevation.
Pharyngeal Swallow
4. Cricopharyngeal opening: tension in the
cricopharyngeal muscle portion of the sphincter is released.
Laryngeal anterior-superior motion opens the sphincter,
sphincter is yanked open by the motion of the larynx
resulting from the upward and forward pull of the floor of
mouth muscles. Pressure w/in bolus widens the opening.
Once passed, larynx lowers and cricopharyngeal muscle
returns to level of contraction.
Pharyngeal Swallow
5. Tongue base and pharyngeal wall action: when bolus
reaches tongue base level, tongue base and pharyngeal
walls should make complete contact during the swallow.
Move towards each other, pressure builds. Pharyngeal wall
contracts and continues down pharynx to UES.
Peristalsis
Progressive contraction
down a muscular tube
Pressure generated by
TBR and pharyngeal
wall constriction
increases w/ bolus
viscosity. Pressure
applied to the tail of the
bolus.
Movement
Velopharyngeal closure and hyolaryngeal excursion
occurs simultaneously
Open UES and airway closure
Pressure on bolus
1. oral tongue pushes tail
2. tongue base reaches pharyngeal wall and apply
pressure to bolus.
Movement
Pharyngeal transit time time bolus to move from point
Esophageal Phase
Time from UES to LES/stomach varies 8-20 seconds.
UES musculoskeletal
valve (cricopharyngeal
muscle & cricoid cartilage)
LES muscular sphincter.
Keep food/stomach acid in
stomach
Infant
Swallow begins in the fetus. Sucking nipple, infant
Older Adult
Number of chewing strokes related to age and dental
w/out aspiration
Longer esophageal
transit
cricopharyngeal
opening less change
as volume increased,
exacerbates w/
weakness
Taste intensity of
taste & smell are
reduced
2.
3.
4.
5.
6.
https://www.youtube.com/watch?v=_Aw7EkIsYK0
https://www.youtube.com/watch?v=-4yKOC1QT9M