1
Swallowing Phases 12.2
● Terms
○ Mastication- chewing, preparing food for swallowing
○ Deglutition- the process of swallowing
○ Bolus- food or liquid to be swallowed
○ Aspiration- material enters into the airway below the level of the vocal folds
● Instrumental Assessment
○ FEES- flexible endoscopic evaluation of swallow
○ MBSS/VFS- modified barium swallow study or videofluoroscopic swallow
study
● The lip and jaw closure are requirements for mastication and proper bolus control
● The faucial pillars are involved in triggering swallow
● Spaces
○ Valleculae- between the tongue base and epiglottis
○ Pyriform sinuses- lateral and they funnel toward the esophagus
● Normal swallow: 4 stages
○ Oral preparatory phase
■ Introduction of food, mastication until ready to swallow
○ Oral stage
■ Bolus moved posteriorly to faucial pillars/ tongue base
○ Pharyngeal stage
■ Reflexive initiation of pharyngeal swallow to entry into the
esophagus
○ Esophageal phase
■ Entry into the esophagus at UES and entry into the stomach at LES
● Review
○ Cranial nerves are involved in sensory in the tongue
■ CN VII, IX, X
● Oral preparation
○ Sensory recognition of food approaching the mouth
○ Adequate sensory feedback of food in the mouth is critical to the initiation
of oral phase movement
○ Voluntary process but can be done automatically
■ Lips close, facial tone, rotary jaw movement, tongue motion, soft
palate opens to enable nose breathing
● Oral preparatory phase– Liquids
○ The labial seal is required
○ Requires the ability to breathe nasally
, 2
○ Dippers vs Tippers: tongue contacts the anterior alveolar ridge OR floor of
the mouth
○ Liquid (for most): tongue holds bolus between tongue and anterior hard
palate, cups around liquid → tipper
○ 20% of normal swallowers are dippers
○ Aberrant = tongue thrust
● Oral preparatory phase
○ Larynx and pharynx at rest
■ Airway is open
○ Nasal breathing continues
● Deficits in the oral prep stage
○ Weakness in tongue and buccal muscles >> pocketing food in cheek cavity
○ Weak muscles of mastication >> inadequately chewed food
○ Attention problems: may not complete mastication/ prep process
○ Weak velum
■ May not be fully depressed
■ The tongue may not be elevated in the back
● Oral phase
○ Bolus is propelled toward faucial pillars
○ Initiated when tongue begins bostieor movement of bolus
○ Duration: less than 1-1.5 sec
○ Sides and tip of tongue remain firmly anchored to alevelor ridge
○ Chewing stops and bolus is squeezed back toward the faucial pillars
○ Oral phase ends at faucial pillars
■ May extend more postierorly (tongue base) as we age
● Oral phase: physiology
○ Muscular action for oral stage
■ Mandibular muscles- elevate the mandible
● Masseter, temporalis, and medial petyrgoid
■ Tongue muscles
● Move tongue body- genioglossus
● Elevates tongue and floor of mouth- mylohyoid
● Elevated tongue tip- superior longitudinal
● Cup tongue- vertical and genioglossus
● Relaxes posterior tongue- palatoglossus
● Retracts and elevates tongue- styloglossus
● Oral phase: symptoms and disorders
○ Weakness
■ Increased oral transit time
Swallowing Phases 12.2
● Terms
○ Mastication- chewing, preparing food for swallowing
○ Deglutition- the process of swallowing
○ Bolus- food or liquid to be swallowed
○ Aspiration- material enters into the airway below the level of the vocal folds
● Instrumental Assessment
○ FEES- flexible endoscopic evaluation of swallow
○ MBSS/VFS- modified barium swallow study or videofluoroscopic swallow
study
● The lip and jaw closure are requirements for mastication and proper bolus control
● The faucial pillars are involved in triggering swallow
● Spaces
○ Valleculae- between the tongue base and epiglottis
○ Pyriform sinuses- lateral and they funnel toward the esophagus
● Normal swallow: 4 stages
○ Oral preparatory phase
■ Introduction of food, mastication until ready to swallow
○ Oral stage
■ Bolus moved posteriorly to faucial pillars/ tongue base
○ Pharyngeal stage
■ Reflexive initiation of pharyngeal swallow to entry into the
esophagus
○ Esophageal phase
■ Entry into the esophagus at UES and entry into the stomach at LES
● Review
○ Cranial nerves are involved in sensory in the tongue
■ CN VII, IX, X
● Oral preparation
○ Sensory recognition of food approaching the mouth
○ Adequate sensory feedback of food in the mouth is critical to the initiation
of oral phase movement
○ Voluntary process but can be done automatically
■ Lips close, facial tone, rotary jaw movement, tongue motion, soft
palate opens to enable nose breathing
● Oral preparatory phase– Liquids
○ The labial seal is required
○ Requires the ability to breathe nasally
, 2
○ Dippers vs Tippers: tongue contacts the anterior alveolar ridge OR floor of
the mouth
○ Liquid (for most): tongue holds bolus between tongue and anterior hard
palate, cups around liquid → tipper
○ 20% of normal swallowers are dippers
○ Aberrant = tongue thrust
● Oral preparatory phase
○ Larynx and pharynx at rest
■ Airway is open
○ Nasal breathing continues
● Deficits in the oral prep stage
○ Weakness in tongue and buccal muscles >> pocketing food in cheek cavity
○ Weak muscles of mastication >> inadequately chewed food
○ Attention problems: may not complete mastication/ prep process
○ Weak velum
■ May not be fully depressed
■ The tongue may not be elevated in the back
● Oral phase
○ Bolus is propelled toward faucial pillars
○ Initiated when tongue begins bostieor movement of bolus
○ Duration: less than 1-1.5 sec
○ Sides and tip of tongue remain firmly anchored to alevelor ridge
○ Chewing stops and bolus is squeezed back toward the faucial pillars
○ Oral phase ends at faucial pillars
■ May extend more postierorly (tongue base) as we age
● Oral phase: physiology
○ Muscular action for oral stage
■ Mandibular muscles- elevate the mandible
● Masseter, temporalis, and medial petyrgoid
■ Tongue muscles
● Move tongue body- genioglossus
● Elevates tongue and floor of mouth- mylohyoid
● Elevated tongue tip- superior longitudinal
● Cup tongue- vertical and genioglossus
● Relaxes posterior tongue- palatoglossus
● Retracts and elevates tongue- styloglossus
● Oral phase: symptoms and disorders
○ Weakness
■ Increased oral transit time
