Disorders of Swallowing Ch. 4

Oral Preparatory Phase Break down food into a bolus Mix with saliva Bring it together Bolus is ready to swallow https://www.youtube.com/watch?v=hxgetjdqsTQ- straw drinking Oral Preparatory Phase

Disorders in the Oral Preparatory Phase Cannot Hold Food in Mouth Anteriorly Reduced Lip Closure ?Mouth breather Cannot Hold a Bolus Reduced Tongue Shaping/Coordination Reduced soft palate movement down/forward against back of tongue Possible aspiration if bolus goes over back of tongue before ready Disorders in the Oral Preparatory Phase

Disorders of the Oral Preparatory Phase Cannot Form a Bolus Reduced range of Tongue Motion or Coordination Unable to pull all the pieces together Material Falls into the Anterior Sulcus Reduced Labial Tension/Tone Inadequate closure of the anterior sulcus Material Falls into the Lateral Sulcus Reduced Buccal Tension/Tone Disorders of the Oral Preparatory Phase

Disorders of the Oral Preparatory Phase Abnormal Hold Position Reduced Tongue Control Tongue Thrust Held against the front teeth Can push the food out of the oral cavity Disorders of the Oral Preparatory Phase

Oral Phase Lingual propulsion of the bolus Moves bolus posteriorly through the oral cavity Oral Phase

Disorders of the Oral Phase Delayed Oral onset of swallow Reduced oral sensation Lack of recognition of bolus to be swallowed Tongue moves forward to start swallow Tongue Thrust Can be preceded by an abnormal hold position of the bolus Residue in Anterior Sulcus Reduced Labial Tension/Tone Residue in Lateral Sulcus Reduced Buccal Tension/Tone Disorders of the Oral Phase

Disorders of the Oral Phase Residue on the Floor of the mouth Reduced tongue shaping Poor seal of tongue to anterior and lateral alveolus Residue of Food on the Tongue Reduced tongue range of motion Reduced tongue strength Disorders of the Oral Phase

Disorders of Oral Phase Incomplete Tongue-Palate contact Reduced Tongue Elevation Reduced range of vertical tongue motion Residue of food on Hard Palate Reduced Tongue strength Disorders of Oral Phase

Disorders of Oral Phase Reduced Anterior-Posterior Tongue Movement Reduced Lingual Coordination Uncontrolled Bolus/Premature Spillage Reduced Tongue control Reduced Linguavelar seal Piecemeal Deglutition Poor bolus formation Poor tongue coordination https://www.youtube.com/watch?v=rUUtrDb6rg4 https://www.youtube.com/watch?v=jr2CuFRCsP8 Disorders of Oral Phase

Disorders in Triggering Pharyngeal Swallow Delayed Pharyngeal Swallow Reduced oralpharyngeal sensation of bolus Cranial Nerve damage Disorders in Triggering Pharyngeal Swallow

Disorders of Pharyngeal Phase Nasal Penetration during swallow Reduced velopharyngeal closure Bony Outgrowth from Cervical Vertebrae Narrow the pharynx May have the sense that “something is there” when they swallow Residue on one side of Pharynx Unilateral Pharyngeal wall weakness- constrictors Disorders of Pharyngeal Phase

Disorders of Pharyngeal Phase Coating on Pharyngeal Walls after the study Reduced pharyngeal contraction bilaterally Valleculae residue after the swallow Reduced tongue base posterior movement Reduced bulging posterior pharyngeal wall contacting tongue base Residue at Top of airway Reduced laryngeal elevation Disorders of Pharyngeal Phase

Disorders of Pharyngeal Phase Laryngeal Penetration and Aspiration after the swallow Reduced vocal fold closure Residue in pharynx, valleculae or pyriform sinuses Aspiration During the Swallow Reduced epiglottic inversion Reduced false vocal fold closure (aryepiglottic fold) Disorders of Pharyngeal Phase

Disorders of Pharyngeal Phase Residue in pyriform sinuses Reduced anterior laryngeal movement Upper Esophagus Sphincter dysfunction Esophageal stricture Residue throughout the pharynx Decreased pharyngeal pressure Decreased pharyngeal constriction Disorders of Pharyngeal Phase

Disorders of Pharyngeal Phase Increased pharyngeal transit time >1 second Decreased pharyngeal constriction Decreased pharyngeal coordination https://www.youtube.com/watch?v=sM6uxd1uS6M https://www.youtube.com/watch?v=ry3u2mWTfqo Disorders of Pharyngeal Phase

Disorders of Cervical Esophageal Phase Esophageal-to-Pharyngeal Backflow Upper Esophageal Sphincter dysfunction Frequent gagging/coughing Potential for aspiration Burning sensation in the pharynx Tracheoesophageal Fistula Hole that develops in the soft tissue common wall between the trachea and the esophagus Between the 1st to 3rd thoracic vertebrae Backflow into the trachea from the esophagus Coughing after the swallow Disorders of Cervical Esophageal Phase

Disorders of Cervical Esophageal Phase Zenker’s Diverticulum Side pocket that forms when the pharyngeal or esophageal muscle herniates Forms in the area of the Upper esophageal sphincter Material collects in this pocket and usually empties after the swallow Reflux Backflow of food and stomach acid from the stomach to the esophagus Failure of the Lower Esophageal Sphincter https://www.youtube.com/watch?v=Fn4pB_TJhEk Disorders of Cervical Esophageal Phase