Mechanism Of Swallowing Learning Objectives: At the end of the lecture, the student should be able to: Define Swallowing.

lowing. Describe the anatomy of the swallowing mechanism. Explain the deglutition process. Stages of swallowing. Coordination of swallowing and respiration. Mechanism of swallowing. Swallowing reflex.

igestive S!stem: Organ s!stem that processes food extracts nutrients from it and eliminates the residue.

igestive "rocesses:

#ngestion. "ropulsion. igestion. Mechanical digestion. $hemical digestion. Absorption. efecation.

Swallowing: The term swallowing refers to: Entire act of deglutition from placement of food in mouth, Manipulation of food in oral ca ity, oral, pharyngeal and esophageal stages of swallowing until food enters stomach.

Anatom! of the swallowing mechanism: %he anatomic area of swallowing mechanism consists of the oral cavit!, phar!nx, lar!nx and esophagus.

Mechanism Of Swallowing: A complicated mechanism, principall! because phar!nx subserves respiration as well as swallowing. "har!nx is converted for onl! a few seconds at a time into a tract for propulsion of food. &espiration not to be compromised because of swallowing.

"h!siolog! of swallowing mechanism: Swallowing is composed of four distinct phases: '( Oral preparator! phase, ) ( Oral phase, * ( "har!ngeal phase + ( ,sophageal phase.

uration and characteristics of these phases are highly dependent on: -olume and t!pe of the food . -oluntar! control on swallowed bolus.

Some types of swallow do not involve all phases,

/or example swallowing sali a in pharynx does not include oral preparatory and oral phases of swallow.

"h!siolog! of eglutition 0Swallowing1:

Moving bolus from mouth to stomach:

!acilitated by sali a, mucous secretions. "n ol es mouth, pharynx, and esophagus.

2uccal phase: #oluntary. Mo es bolus to oropharynx.

Oral "reparator! "hase: !ood is prepared for swallowing and then transported to the pharynx.

$ preparatory phase in which the food is held within the mouth while the base of the tongue and the soft palate close the oral ca ity posteriorly to pre ent food spilling into the open larynx and trachea.

%he oral phase:

$ bolus is formed in the central portion of the tongue and then pushed posteriorly toward the pharynx with an anterior%to%posterior tongue ele ation. $s the bolus enters the pharynx the actual swallow or phar!ngeal reflex is triggered.

"har!ngeal phase: A reflex action. 2olus passes through phar!nx 3uic4l! and then enters esophagus. %his ta4es place in less than a second. #nitiation of this process starts when the bolus passes the anterior faucial arch and reaches the posterior phar!ngeal wall.

,levation of soft palate prevents material from entering nasal cavit!. %his stage is followed b! phar!ngeal constrictor muscles pushing bolus further into the phar!nx, toward cricophar!ngeal sphincter. Lar!nx prevents material from entering trachea b! respectivel! closing the true vocal cords, false vocal folds, and ar!epiglottic folds. $ontraction of lower phar!ngeal constrictor is followed b! relaxation of the cricophar!ngeal muscle, allowing the bolus to pass into the esophagus.

*.,sophageal stage &pper esophageal sphincter closes 'astroesopaheal sphincter opens Esophagus controls in oluntary peristaltic mo ement Epiglottis reopens (olus mo es from esophagus to stomach.

This phase begins when the bolus enters the esophagus at &ES. Then, peristaltic wa es of esophagus push the bolus se)uentially downward until it reaches the *ES and enters the stomach. This phase lasts from + to ,- seconds. "n the esophageal phase, the epiglottis returns to its rest position and the airway opens while the esophageal peristalsis mo ement continues.

$oordination of swallowing and respiration:

Swallowing and respiration are reciprocal functions, i.e., respiration halts .apnea periods/ during the pharyngeal phase of a swallow. During oral preparatory, oral and esophageal phases, airway is entirely open. Coordination of respiration and swallowing is crucial for a normal swallow and any mismatch results to aspiration.

"n the predominant pattern of coordination, swallow interrupts exhalation and sub0ect returns to exhalation at end of the swallow. Exhalation at the end of the swallow clears the larynx and pharynx form small residues of materials and pre ent them from entering the airways. /lowchart showing 5ormal 2reath Swallow "attern. Mechanism of swallowing: Multiple sensory and motor systems must function to assure a smooth swallowing process. li)uid or food has to be percei ed in the mouth. tongue directs contents into bac1 of the mouth .pharynx/.

$t this point, simultaneously, breath must be held, the wind pipe%%which is in front of the food pipe%%has to close off to pre ent aspiration, and muscles of pharynx ha e to contract to propel the food into the esophagus. as food is in esophagus, the windpipe has to open up again and breathing has to resume. This delicate interplay between the respiratory systems and the digesti e system re)uires perfect timing and synchrony of e ents to pre ent cho1ing, regurgitation, aspiration, asphyxia, omiting .

Soft palate and u ula raise. 2yoid bone and larynx ele ate. Epiglottis closes off top of trachea. *ongitudinal muscles of pharynx contract. "nferior constrictor muscles relax and esophagus opens. 3eristaltic wa es push food through pharynx.

Mechanism of swallowing: Central ner ous system controls for both mechanisms are in the brain stem. modulated by higher centers scattered throughout the midbrain and the cortex of the brain. Smooth operation of the process re)uires at least a relati ely healthy brainstem.

Swallowing disorders 0Dysphagia1 Dysphagia: Difficulty in swallowing. May also experience pain while swallowing. Some people may be completely unable to swallow or may ha e trouble swallowing li)uids, foods, or sali a.