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Normal Swallowing - Coggle Diagram
Normal Swallowing
Oral prep phase
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Mastication, combine food with saliva, tasting food, forming bolus of appropriate size, consistency to move into next stage
Duration depends on bolus consistency, under volitional control
Airway is open, breathing mainly via nasal airways
Structures: Lips, anterior 2/3 of tongue for bolus prep, extrinsic and intrinsic muscles to shape bolus
Liquids: BOT raised, velum lowered, draped close to BOT
Solids: Tongue moves bolus laterally to molar ridges, crushing rotatory mvt of jaw masticates bolus, crushing continues reflexively, can also be cortical input.
Active chewing: Velum is in normal resting position up away from BOT, prem spillage NORMAL
No active chewing: Velum draped down and forward to touch BOT, partially seal off oral cavity from pharynx
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Neuro
Brainstem then integrated in nucleus tractus solitarius of medulla & cortical control: Info taste, temp, bolus size, how much to masticate
Pharyngeal phase
Hyoid mvt--> Cricopharyngeal (CP) sphincter [UES] opens to allow bolus to pass into oesophagus. Once bolus passed, larynx returns to original position, CP returns to original position
Progressive contraction pharyngeal constrictor muscles (Superior pharyngeal constrictor, medial, inferior): Pharyngeal stripping wave to help w bolus transport
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FEES: triggered when bolus begins to pass around epiglottis, reaches lateral channels. Liquid bolus divides at valleculae--> travels down pharynx in pyriform sinuses, then meets again at oesophagus. Solid stays as a whole, goes down 1 side
Swallowing initiation depends on sensory information: mechanical, chemical, water respondent receptors
Sensory receptors: oropharynx, tongue identify posterior propulsion of bolus, send sensory info via sensory branch of CN10 vagus to nucleus tractus solitarius--> decoded--> sent to nucleus ambiguous--> initiate pharyngeal swallow motor pattern
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Velum closes off nasal cavity- CN9 palatopharyngeal muscle, CN10,11 levator veli palatini
Hyoid moves up and forward, larynx elevates, TVF closes, closes laryngeal entrance (FVF adduct, arytenoid medialise and tilt anteriorly, epiglottic base thickens). Epiglottis deflects over laryngeal entrance, closes laryngeal vestibule
Cranial nerves
CN5: mylohyoid, anterior belly of digastric
CN12: Hypoglosus, geniohyoid
Oral phase
General info
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Tongue propels bolus into oropharynx then into hypopharynx. Ends with trigger of swallow. Reflex and voluntary
Bolus held in mid-central groove w lateral edges of tongue against hard palate, lateral side of teeth
Lips, buccal muscles contract, velum raised and retracted to close off nasopharynx. Build up pressure in pharynx. Inward mvt of posterior, lateral pharyngeal walls
Posterior of tongue depresses, anterior tongue presses against hard palate propelling bolus backward-stripping action
Structures: Intrinsic muscles of tongue, change shape of tongue to form groove for bolus. Extrinsic muscles of tongue
Cranial nerves
CN5: digastric, mylohyoid
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Oesophageal phase
Stage starts w bolus moving through CP sphincter, stops when bolus reaches LES at opening of stomach
Bolus transported by peristaltic waves, push bolus through-> into LES--> into stomach