1. Disorders of Swallowing
Ch. 4

2. Oral Preparatory Phase
Break down food into a bolus
Mix with saliva
Bring it together
Bolus is ready to swallow
straw drinking
Oral Preparatory Phase

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. 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
Disorders of Oral Phase

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

12. 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

13. 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

14. 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

15. 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

16. Disorders of Pharyngeal Phase
Increased pharyngeal transit time >1 second
Decreased pharyngeal constriction
Decreased pharyngeal coordination
Disorders of Pharyngeal Phase

17. 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

18. 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
Disorders of Cervical Esophageal Phase