1. 1 Velopharyngeal Function 2/17/00

2. 2 Soft Palate Posterior extension of soft palate Composed of muscular fibers Movement changes volume & shape of the nasal & oral cavities Speech: nasal-nonasal phonetic distinction –“Closed”- Soft palate elevated and seals against posterior pharyngeal wall –“Meaning”- Soft palate is lowered (acoustic energy passes through nasal cavity) Swallow: Soft palate closes when bolus passes from oral cavity to pharynx

3. 3 Muscles: Soft Palate Levator veli palatini Tensor veli palatini Uvula Palatoglossus Palatopharyngeus

4. 4 Levator Palatini Temporal Bone Elevates the soft palate Pull soft palate toward post. pharyngeal wall Dilates eustachian tube

5. 5 Tensor Veli Palatini Eustachian Tube Dilation of eustachian tube Tenses the palate assisting in velopharyngeal closure

6. 6 Uvula Medial & posterior portions of the soft palate Arises from posterior nasal spine of palatine bone & palatal aponeurosis Fibers run the length of the soft palate Inserts into mucous membrane of the velum Contraction shortens the velum, bunching it up

7. 7 Palatoglossus Anterior facial pillars Depresses sides of soft palate Pulls sides of tongue up and back

8. 8 Palatopharyngeus Soft Palate Palatoglossus Palatine Tonsil Palatopharyngeus Anterior Faucial Arch Posterior Faucial Arch Posterior facial pillar Depress soft palate Elevate pharynx or larynx

9. 9 Patterns: Velopharyngeal Closure Basic action the same in speech & swallowing –Close the entry into the nasal cavity or open it Sex differences: –Males velum forms acute angle in the orientation to the PPW –Females have a right angle orientation –Extent of the area of the velopharyngeal seal is greater in females –Midpoint of closure in the nasopharynx Superior to palate in males Inferior to palate in females

10. 10 Patterns of Velopharyngeal Action A. B. C. D. Velum Velopharyngeal Port Lateral Pharyngeal Wall Passavant’s Ridge A. Coronal (A-P movement of velum) B. Sagittal (Lateral pharyngeal wall movement) C. Circular (Equal movement of lateral pharyngeal wall and velum) D. Circular with Passavant’s Ridge (Lateral pharyngeal wall, velum & posterior pharyngeal wall)

11. 11 Velopharyngeal Function & Age 3- 5 years: velar-adenoidal valving –exploits large adenoidal mass in young children Nasal airway narrow Adenoid atrophy changes pattern

12. 12 Velopharyngeal Actions Velum Elevation: –Levator Palatini –Velar positioning: Levator veli palatini Palatoglossus Palatopharyngeus Velum Lowering: –Muscle contraction Palatoglossus Palatopharyngeus –Gravity –Tissue Elasticity

13. 13 Swallowing

14. 14 Deglutition Main purpose: Transportation of bolus (mass of masticated food ready to be swallowed) from oral cavity to the stomach Sequence of Muscular Action: –Trap bolus in the anterior region of oral cavity –Move the bolus from the mouth to entrance of pharynx –Admit the bolus into the esophagus, while entrance into larynx is closed –Transport bolus to esophagus to stomach

15. 15 Swallow: Structures Involved Lips (Anterior Seal) Tongue (Anterior Seal) Soft Palate (Closes velopharynx-Midpalatal) (Opens-Esophageal) Pharynx (Opens for bolus) Larynx (Vocal folds close) Esophagus (Superior sphincter opens-Peristaltic transport) Interruption of respiration: Apneic Interval

16. 16 Stage Descriptions

17. 17 Containment Stage Anterior seal formed by the lips & tongue tip or blade Bolus held in a depression at the front of the tongue Dorsum of tongue arches upward to assist bolus containment Tongue performs a pooling action to contain the bolus Posterior seal by the soft palate (descending to make contact with the tongue

18. 18 Midpalatal Stage Bolus squeezed aborally (away from mouth) by progressive wavelike elevation of the tongue (anterior) Dorsum of tongue lowered to receive bolus Soft palate elevated in advance of the bolus to open the oropharyngeal channel & close the VP port

19. 19 Pharyngeal Compression Stage Begins: Bolus reaches faucial pillars & soft palate Onset of reflexive control of deglutition –Cessation of respiratory activity (apnea) Tongue flexes backward on hyoid bone to thrust bolus posteriorly into the pharynx –Vigorous tongue motion necessary

20. 20 Pharyngeal Engulfing Stage Larynx moves superior-anterior to tuck under the root of the tongue Epiglottis tips downward & backward to protect the opening into the larynx False & true vocal folds adduct to form a laryngeal constriction –prevents solid & liquid from entering the larynx Elevation of pharyngeal tube to “engulf” bolus –Peristaltic wave: Involuntary contraction Superior esophageal sphincter opens receiving bolus

21. 21 Esophageal Stage Bolus moved by esophageal peristaltic contraction to the gastroesophageal sphincter (entrance to stomach) Respiration begins, soft palate descends to rest position

22. 22 Stages of Swallow

23. 23 Bolus Transport Time Oropharyngeal Time= 2 seconds (young adults); 3-4 seconds (older adults) Esophageal Time= 0.5-1 second –liquids have faster times

24. 24 References Arvedson, J.C., & Rogers, B.T. (1993). Pediatric swallowing and feeding disorders. Journal of Medical Speech Language Pathology, 1, 203-221. Kennedy, J.G., III, & Kent, R.D. (1985). Anatomy and physiology of deglutition and related functions. Seminars in Speech and Language, 6, 257-273.