4Deglutition (Swallowing) Involves the coordinated activity of the tongue, soft palate, pharynx, esophagus and 22 separate muscle groupsBuccal phase – bolus is forced into the oropharynxPharyngeal-esophageal phase – controlled by the medulla and lower ponsAll routes except the one into the digestive tract are sealed offPeristalsis moves food through the pharynx to the esophagus
5infantile (or immature) swallow has the following characteristics:1. The jaws are apart, with the tongue between the gum pads;2. The mandible is stabilized mainly by contraction of the muscles innervated by the VII (seventh) cranial nerve and the interposed tongue;3. The swallow is guided and to a great extent controlled by sensory interchange between the lips and the tongue
6mature swallowUsually, by 18 months of age, the following mature swallow characteristics are to be observed:1. The teeth are together;2. The mandible is stabilized by contraction of the mandibular elevators, these being primarily innervated by the trigeminal nerve;3. The tongue tip is held against the palate above and behind the incisors;4. There are minimal contractions of the lips during the mature swallow.
7Theories of deglutition THEORY OF CONSTANT PROPORTIONTHEORY OF ORAL EXPULSIONTHEORY OF NEGATIVE PRESSURETHEORY OF INTEGRAL FUNCTION
8THEORY OF CONSTANT PROPORTION 1. Oral phase; the bolus is formed and transported under voluntary control to the pharynx;2. Pharyngeal phase; following receipt of the bolus, the pharynx is activated to propel the food to the oesophagus;3. Oesophageal phase; passage of bolus down the oesophagus to the stomach by oesophageal contraction
9THEORY OF INTEGRAL FUNCTION based on cinefluorographic, myometric and electromyographic studies, and considers that the act of deglutition is a total dynamic process. This is the currently accepted theory
10THEORY OF INTEGRAL FUNCTION Phases of the mature deglutition cycle1. Preparatory phase2. Oral phase3. Pharyngeal phase4. Oesophageal phase
121. Preparatory phasestarts as soon as liquids are taken into the oral cavity or after the bolus has been masticated.The liquid or bolus is position on the dorsum of the tongue, with the oral cavity sealed by the lip and the tongue.The positioning of a liquid on the dorsum of the tongue before transporting it to the final swallow-preparatory position may be facilitated through suction created by moving the tongue posteriorly after a peripheral seal has been established within the cavity.
131. Preparatory phaseA final characteristic is the stabilization of the oral cavity'Considerable pressure' is exerted between the teeth in the molar region as the lip is elevated to position the bolus in adult subjects, although it is apparent that in the predentition or mixed dentition phases, other mechanisms would need to be used for this purpose.
142. Oral phaseintroduced by the withdrawal of the soft palate from its rest position against the root of the tongue, where it is held by the tensor palati muscles.In this phase the soft palate moves upward and the tongue drops downward and backward.At the same time, the larynx and hyoid move upward.The elevation of the hyoid may actually be initiated as the bolus is positioned in the swallow-preparatory phase.
152. Oral phaseThese combined movements make a smooth path for the bolus as it is pushed from the oral cavity by the peristaltic-Iike action of the tongue.Solid food is actually pushed by the tongue, whereas fluids flow ahead of the lingual contractions.During this phase, the oral cavity maintains an anterior and lateral seal, and is stabilized by the muscles of mastication.
162. Oral phaseWhen a large bolus is to be swallowed, most or all of it is moved into the preparatory position and is then neatly sectioned by the tongue in consecutive swallows until the oral cavity is empty.
183. Pharyngeal phaseThis phase begins as the bolus passes from the tongue through the fauces.The pharyngeal tube is raised and the nasopharynx sealed by closure of the soft palate against the posterior pharyngeal wall.Active participation of the pharynx is elicited by soft palate and bolus contact with the pharyngeal wall, an action which consists of an elevation of the entire
193. Pharyngeal phasepharyngeal tube and a sphincteric reduction in the lumen between the upper pharyngeal wall and soft palate.The hyoid and the base of the tongue move forward as both the tongue and the pharynx continue their peristaltic-like action on the food bolus.Passage of such a bolus through the pharynx during the mature swallowing is enhanced by an anterior movement of the hyoid and root of the tongue.
203. Pharyngeal phaseFinally, there is an abrupt elevation of the larynx as the bolus reaches the laryngo-pharynx and, this is then followed by elevation of the floor of the laryngophary and opening of the oesophageal sphincter.
224. Oesophageal phaseThis phase commences as soon as food passes the cricopharyngeal sphincter. While peristaltic movement carries the food through the oesophagus, the hyoid bone, soft palate and tongue return to their 'original positions'.
25Esophagus Insert 18.4a Peristalsis: Wave-like muscular contractions: Produced by a series of localized reflexes in response to distention of wall by bolus.Wave-like muscular contractions:Circular smooth muscle contract behind, relaxes in front of the bolus.Followed by longitudinal contraction (shortening) of smooth muscle.Rate of 2-4 cm/sec.After food passes into stomach, LES constricts.Insert 18.4a
27Stomach Most distensible part of GI tract. Functions of the stomach: Empties into the duodenum.Functions of the stomach:Stores food.Initiates digestion of proteins.Kills bacteria.Moves food (chyme) into intestine.
29Oral Preparatory Phase tongue positions material on the teethrotary lateral movement of the mandible and tongue during masticationtongue moves the material back onto the teeth as the mandible opensafter cycle is repeated numerous times, a bolus is formedduring active chewing, the soft palate is not pulled down and forward and premature spillage is common and entirely normal
31Pharyngeal Phaseelevation and retraction of the velum and complete closure of the velopharyngeal to prevent passage into the nasopharynxelevation and anterior movement of the hyoid and larynxclosure of the larynx at the true vocal folds, the laryngeal entrance and the epiglottis to prevent material from entering the airway
33Second swallow A second swallow was needed to clear all the material 1/3 Teaspoon Ground Meat and 1/4 Cookie In this segment, please note:The rotary lateral movement of the mandible and tongueThe formation of the bolusDuring chewing, the soft palate is not pulled down and forward and material falls into the pharynx partially before the pharyngeal phase is triggeredBolus size decrease with the viscosity of food; J.P. swallowed twice on the ground meat material
37Speech 1 Speech Mechanism Physiological phonetics All sounds which come from the mouth and nose arethe result of interruptions and/or modifications of a stream of air moving from the lungs through:trachea - larynxpharynx - oral cavitynasal cavity
39Articulation structures of pharynx, nasal and oral cavity way of modifying airstreamarticulation = joining together of speech organs for production of phonemes
40lips – supported by maxilla (upper jaw) and lower jaw (mandible) – Body function - receive and contain food– Speech function - varied movement: rounded, tensed: obstruct air flow
41teeth– body function - cut and grind food– speech function - anatomical obstacle for lips ortonguealveolar ridge (gum ridge of maxilla– body function - none; houses teeth– speech function - point of contact/constriction
42hard palate - bony structure posterior to alveolar ridge – body function - contain food in oral cavity– speech function - point of contact; defines shape of oral cavity
43soft palate/velum - muscular structure posterior to hp – body function - separate oral cavity and nasalcavity– speech function - direction of air flow -open/close vp port: point of contact
44tongue -major articulator/ muscle and mobile – body function - direct food to back of oral cavity– speech function - direction of air flow: contacts
45other structures : approximates other structures; changes size of oral cavity mandible– body function - chewing– speech function - change size of oral cavity
46Oral cavity– from mouth opening to posterior wall of pharynx (posterior pharyngeal wall)– body function: breathing, eating– speech: channels airstream: contributes oral resonanceNasal cavity - extends from nostrils (nares) to posterior
47Pharynx– posterior portion of nasal cavity down through back of oral cavity to larynx– body function: breathing– speech: contributes nasal resonanceVocal cords/folds– in lateral walls of larynx– body function: respiratory protection– phonation