General
What are the 4 stages of swallowing
1. oral prep
2. oral transit
3. pharyngeal
4. esophageal
The muscles of mastication are innervated by this cranial nerve
cranial nerve V (trigeminal)
Most affected swallowing phase from presbyphagia
what is pharyngeal phase (hyoid movement declines decreasing the opening of UES)
2 adaptive oral reflexes
rooting and suckling
Root of all evil
GERD
The 2 main goals of swallowing are
bolus efficiency & airway protection
Describe the function of the masseter superficial muscle
elevates and protracts the mandible
Structures affected in head and neck cancer
soft palate, tongue, larynx, tonsils
Differences in oral structures compared to an adult
smaller oral cavity and jaw, larger buccal fat pads and tongue, Newborn larynx is positioned higher, Uvula and epiglottis are in contact
Risk factors for head and neck cancer
tobacco and heavy alcohol use, HPV, poor oral hygiene, processed foods, radiation, mechanical irritation (men are more likely to get HNC)
Describe the first phase of swallowing
food is masticated in preparation for transfer
Describe the function of the masseter deep muscle
elevates and retracts the mandible
During this swallowing maneuver, you hold tongue between your teeth and swallow. It improves posterior pharyngeal wall movement
Masako
Name at least 3 of the protective reflexes
tongue protrusion, tongue lateralization, phasic bite, gag reflex, coughing, laryngeal chemoreflex, swallow
Name 3 swallowing strategies that can be used during therapy
masako, mendelsohn, shaker, effortful swallow, chin tuck, 3 second swallow prep, double swallow
Describe the third stage of swallowing
material is transported away from oropharynx through a relaxed cricopharyngeal muscle into the upper esophagus
This muscle elevates and protracts the mandible, assisting the lateral pterygoid in drawing the mandible forward.
Medial pterygoid
Name 2 Esophageal disorders
GERD, Zenker's diverticulum, narrowing of lumen, peristalsis, achalasia, nutcracker esophagus
When solids (purees) should be introduced
6 months
What muscle closes the glottis
Lateral cricoarytenoid (this is innervated by CN X)
Describe the final stage of swallowing
material is transported through the esophagus into the gastric cardia (upper opening of the stomach)
Describe the function of the temoralis muscle
Elevates and retracts the mandible against the maxilla with great force
Describe the Mendelsohn maneuver
Signs of readiness for solids
Good head control
Sit up for a few minutes unassisted
Mouthing of objects
Interest in food
When does tongue protrusion diminish?
3-6 months