Normal Swallow - created from Mind Map

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Oral Prepartory Phase

Oral Transport Phase

Pharyngeal Phase

Esophageal Phase

Step 1: Food is brought into oral cavity. Lips teeth and cheeks grasp food. Lips create anterior oral seal

Step 2: Bolus formation where jaw moves in rotary lateral pattern, tongue positions food on the occlusion side of teeth, buccal tone keeps food from falling into the lateral sulci, and saliva helps break down food.

Step 3: Bolus is contained between the tongue and the palate. The Tongue tip contacts the alveolar ridge to keep bolus in front. The lateral sides of the tongue are up against the teeth to hold bolus. The back of the tongue contacts the soft palate to hold bolus and form the retro-oral seal.

Perioral Muscles

Jaw Depressor Muscles

Facial (VII)

Trigeminal (V)

Spinal C1

Orbicularis oris

Buccinator

Ant. Digastric

Mylohyoid

Lateral pterygoid

Geniohyoid

Muscle of the cheeks

Muscles of the Tongue

Muscles of Mastication

Facial (VII)

Hypoglossal (XII)

Trigeminal (V)

Spinal (C1)

Buccinator

Superior longitudinal

Inferior longitudinal

Transverse

Vertical

elevators

depressors

Temporalis

Masseter

medial pterygoid

Ant. digastric

Mylohyoid

Lateral pterygoid

Geniohyoid

Muscles of the tongue

Muscles of the soft palate

Hypoglossal (XII)

Vagus (X) and Accessory (XI)

Genioglossus

Styloglossus

palatalglossus

Palatopharyngeus

Step 1: Tongue uses a "stripping wave" action to move bolus to the back of the tongue.

1 sec or less

Step 2: Bolus is loaded on to the back of the tongue. The soft palate elevates and the back of the tongue, breaking the retro-oral seal. The tongue dorsum moves down and forward to load bolus.

Step 3: Sensory receptors in the anterior faucial pillars, tongue base, and posterior wall are stimulated by the bolus, triggering the pharyngeal phase of the swallow.

Muscles of the tongue

Hypoglossal (XII)

Intrinsic muscles

Genioglossus

Muscles of the Tongue

Palate elevators

Hypoglossal (XII)

Vagus (X) and Accessory (XI)

Trigeminal

Genioglossus

Hyoglossus

Levator veli palatini

Tensor veli palatini

Musculus Uvulae

Muscles of the tongue

Hypoglossal (XI)

Oropharynx

Vagus (X)

Glossopharyngeal (IX)

Step 1: Soft palate elevates to contact the posterior pharyngeal wall, forming the velopharyngeal seal and preventing the bolus from escaping into the nasopharynx

Step 2: The tongue base propels bolus into the pharynx with a piston like motion while the mandible is kept stabilized.

Step 3: Laryngeal closure

Step 4: (HLAE) They hyoid elevates pulling the larynx with it. Once the hyoid reaches max elevation, the thyroid cartilage continues to be in motion, pulling the larynx up with it.

Step 5: The epiglottis deflects into the horizontal position to allow the bolus to empty out of the valleculae and move laterally toward the pyriform sinuses, away from the laryngeal vestibule.

Step 6: Opening of the Upper Esophageal Sphincter (UES)

Step 7: Bolus is cleared from pharynx

Soft palate eelavators

Vagus (X) and Accessory (XI)

Trigeminal

Levator veli palatini

musculus uvulae

Tensor veli palatini

Muscles of the tongue

Muscles of mastication

Hypoglossus (XII)

Trigeminal

Glottal clossure

Vestibule closure

Arytenoid cartilages move to touch base with epiglottis

Epiglottis deflects to a horizontal position (due to laryngeal elevation, muscular forces, and downward pressure of the bolus!)

RLN of X

Trigeminal (V)

Muscles of cord adduction

Lateral cricoarytnoid

Interarytenoids

Cricothyroid

muscles to move arytnoids to epiglottic base

Thyroarytenoid

Supraglottic Muscles

Muscles of the Larynx

elevation

Ant./Post. Digastric

Geniohyoid

Mylohyoid

Stylohyoid

Spinal (C1)

Facial (VII)

Suprahyoid muscles

Spinal (C1)

Trigeminal (V)

Facial (VII)

Ant. Digastric

Stylohyoid

Post. Digastric

geniohyoid

myohyoid

Movement due to forces of laryngeal elevation

Muscles of the epiglottis

Movement due to forces of hyoid elevation

median hyoepiglottic ligament

Pre-epiglottic adipose tissue

aryepiglotticus

thyroepiglotticus

Lateral hyoepiglottic ligaments

(a) Muscle relaxes

(b) Muscle becomes easy to work open

(c) UES is kept open by upward movement of the hyolaryngeal complex

(d) Bolus helps pushes itself through UES with its own pressure (intrabolus pressure!)

Muscles of the UES opening

Cricopharyngeus

Muscles elevating hyoid

Suprahyoid muscles

(a) Peristalisis (due to contraction of pharyngeal constrictors) move bolus down pharynx

(b) The pharynx shortens making it easier for bolus to move out of it.

Pharyngeal constrictor muscles

Superior, Middle, and Inferior pharyngeal constrictors

Vagus (X) and Accessory (XI)

Muscles shortening the pharynx

Stylopharyngeus

Salpingopharyngeus

Glossopharyngeal (IX)

Vagus (X) and Accessory (XI)

Bolus is transported from pharynx to stomach

Primary Peristalisis: bolus arrives at UES and a persitalic wave moves the bolus to stomach

Secondary Peristalisis: Triggered by feeling of left over food in esophagus aka Intraesophageal distention!

Muscles of peristalisis

outer logngitudinal muscles

inner circular muscles

Vagus (X) - directed by nucleus ambiguus