A&P chapter 11 Flashcards

Positions of the airway, esophagus, and gland Cross-sectional
histological image showing the trachea (airway) anteriorly, the bilobed thyroid gland
flanking the trachea, and the esophagus located posterior to both structures. This
arrangement highlights the anatomical relationships in the cervical region. (Source:
Copyright 1989 by Department of Audiology & Speech Pathology Memphis State
University, Memphis, Tennessee From the W.R. Zemlin Memorial
Website http://zemlin.shs.uiuc.edu Used with permission)

Anatomy of Swallowing

Oral Cavity
The oral cavity, or mouth, is the point of entry of food into the digestive system, illustrated
in Figure 11.2. The food consumed is broken into smaller particles by mastication.
Mastication is the act of chewing of the teeth.
The extensive chemical process of digestion begins in the mouth. As food is being chewed,
saliva, produced by the salivary glands, mixes with the food. Saliva is a watery substance
produced in the mouths of many animals. The chewing and wetting action provided by the
teeth and saliva prepare the food into a mass called the bolus for swallowing. A bolus is a
rounded mass of chewed food or liquid ready to be swallowed. The tongue helps in
swallowing—moving the bolus from the mouth into the pharynx. The pharynx opens to two
passageways: the trachea, which leads to the lungs, and the esophagus, which leads to
the stomach. The epiglottis closes the glottis and food passes into the esophagus and not
the trachea. This arrangement allows food to be kept out of the trachea.

The Salivary Glands

Outside the oral mucosa are three pairs of major salivary glands, which secrete the
majority of saliva into ducts that open into the mouth:
• Submandibular glands: Located on the floor of the mouth, submandibular glands secrete
saliva into the mouth through the submandibular ducts.
• Sublingual glands: As its name indicates, Sublingual glands lie below the tongue. These
glands use the lesser sublingual ducts to secrete saliva into the oral cavity.
• Parotid glands: Positioned between the skin and the masseter muscle near the ears,
parotid glands secrete saliva into the mouth through the parotid duct, which is located
near the second upper molar tooth

The Parotid Glands: Mumps

Saliva

Regulation of Salivation

Over-salivation can occur, for example, if you are stimulated by the smell of food, but that
food is not available for you to eat. Drooling is an extreme instance of the overproduction of
saliva. During times of stress, such as before speaking in public, sympathetic stimulation
takes over, reducing salivation and producing the symptom of dry mouth often associated
with anxiety. When you are dehydrated, salivation is reduced, causing the mouth to feel dry
and prompting you to take action to quench your thirst. Salivation can be stimulated by the
sight, smell, and taste of food. It can even be stimulated by thinking about food. You might
notice whether reading about food and salivation right now has had any effect on your
production of saliva.
How does the salivation process work while you are eating? Food contains chemicals that
stimulate taste receptors on the tongue, which send impulses to the superior and inferior
salivatory nuclei in the brain stem. These two nuclei then send back parasympathetic
impulses through fibers in the glossopharyngeal and facial nerves, which stimulate salivation.
Even after you swallow food, salivation is increased to cleanse the mouth and water down
and neutralize any irritating chemical remnants, such as that hot sauce in your burrito. Most
saliva is swallowed along with food and is reabsorbed so that fluid is not lost.

Saliva is one thing we do not appreciate when things are working well. Xerostomia is a
condition with dry mouth. There are various degrees of dryness. People with Xerostomia
could experience difficulties with dental hygiene, gingiva health, mastication, deglutition,
and speech production. Deglutition is another word for swallowing Xerostomia is common
with chemotherapy, radiation therapy, degenerative disease, diabetes, and hormonal
instability.

Pharynx

The nasopharynx is flanked by the conchae of the nasal cavity, and it serves only as an
airway. At the top of the nasopharynx are the pharyngeal tonsils. A pharyngeal tonsil, also
called an adenoid, is an aggregate of lymphoid reticular tissue similar to a lymph node that
lies at the superior portion of the nasopharynx. The function of the pharyngeal tonsil is not
well understood, but it contains a rich supply of lymphocytes and is covered with ciliated
epithelium that traps and destroys invading pathogens that enter during inhalation. The
pharyngeal tonsils are large in children, but interestingly, tend to regress with age and may
even disappear. The uvula is a small bulbous, teardrop-shaped structure located at the apex
of the soft palate. Both the uvula and soft palate move like a pendulum during swallowing,
swinging upward to close off the nasopharynx to prevent ingested materials from entering
the nasal cavity. In addition, the auditory (Eustachian) tube connects to each middle ear
cavity and opens into the nasopharynx. This connection is why colds often lead to middle
ear infections and why individuals with a cold may complain of a full feeling in their ears. ,
the nasopharynx, is involved only in breathing and speech.

the oropharynx and the laryngopharynx are used for both breathing and digestion. The
oropharynx begins inferior to the nasopharynx and is continuous below with the
laryngopharynx (Figure 11.6, p. 306). The inferior border of the laryngopharynx connects
to the esophagus, whereas the anterior portion connects to the larynx, allowing air to flow
into the bronchial tree.

The oropharynx is a passageway for both air and food. The oropharynx is bordered
superiorly by the nasopharynx and anteriorly by the oral cavity. The fauces are the opening
at the connection between the oral cavity and the oropharynx. As the nasopharynx becomes
the oropharynx, the epithelium changes from pseudostratified ciliated columnar epithelium
to stratified squamous epithelium. Both epithelium cells have multiple layers. Because the
nasopharynx passes only air through the nasal cavity, the covering is rather simple. In
contrast, the oropharynx could interact with incoming food (liquid) and air. Therefore, its
covering is the stratified squamous epithelium, which has protective lining structures. The
oropharynx contains two distinct sets of tonsils, the palatine and lingual tonsils. A palatine
tonsil is one of a pair of structures located laterally in the oropharynx in the area of the
fauces. The lingual tonsil is located at the base of the tongue. Similar to the pharyngeal
tonsil, the palatine and lingual tonsils are composed of lymphoid tissue, and trap and destroy
pathogens entering the body through the oral or nasal cavities.

The laryngopharynx is inferior to the oropharynx and posterior to the larynx. It continues the
route for ingested material and air until its inferior end, where the digestive and respiratory
systems diverge. The stratified squamous epithelium of the oropharynx is continuous with
the laryngopharynx. Anteriorly, the laryngopharynx opens into the larynx, whereas
posteriorly, it enters the esophagus.

The pharynx is involved in both digestion and respiration. It receives food and air from the
mouth, and air from the nasal cavities. When food enters the pharynx, involuntary muscle
contractions close off the air passageways. The pharynx, a short tube of skeletal muscle
lined with a mucous membrane, runs from the posterior oral and nasal cavities to the
opening of the esophagus and larynx.

Positions of Nasal Cavity, Oral Cavity, Pharynx, and Larynx The
pharynx runs from the nostrils to the esophagus and the larynx.

Histologically, the wall of the oropharynx is similar to that of the oral cavity. The mucosa
includes a stratified squamous epithelium that is endowed with mucus-producing glands.
During swallowing, the elevator skeletal muscles of the pharynx contract, raising and
expanding the pharynx to receive the bolus of food. Once received, these muscles relax,
and the constrictor muscles of the pharynx contract. The contraction forces the bolus into
the esophagus and initiating peristalsis.
Usually, during swallowing, the soft palate and uvula rise reflexively to close off the entrance
to the nasopharynx. At the same time, the larynx is pulled superiorly. Epiglottic inversion
happens to cover the glottis (the opening to the larynx); this process effectively blocks
access to the trachea and bronchi. When the food “goes down the wrong way,” it goes into
the trachea. When food enters the trachea, we cough and force the food up and out of the
trachea. Further, the food will move back into the pharynx. The cough is the body’s
mechanism to clear the airway from unwanted matter, such as food, saliva, or other foreign
matters.

Muscles of the Anterior Neck

Muscles That Move the Head

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Posterior and Lateral Views of the Neck The superficial and deep
muscles of the neck are responsible for moving the head, cervical vertebrae, and
scapulas.

Esophagus

Histology of the Esophagus

Passage of Food through the Esophagus

Rhythmic waves of peristalsis (see Figure 11.10), which begin in the upper esophagus,
propel the bolus of food toward the stomach. Peristalsis is the involuntary, wave-like muscle
contraction that moves food and liquids through the digestive tract. Meanwhile, secretions
from the esophageal mucosa lubricate the esophagus and food. Food passes from the
esophagus into the stomach at the lower esophageal sphincter (LES) (also called the
gastroesophageal or cardiac sphincter). Sphincters are muscles surrounding tubes and
serve as valves, closing the tube when the sphincters contract and opening it when they
relax. The lower esophageal sphincter relaxes to let food pass into the stomach, and then
contracts to prevent stomach acids from backing up into the esophagus. Surrounding this
sphincter is the muscular diaphragm, which helps close off the sphincter when food is not
being swallowed.

When the lower esophageal sphincter does not completely close, the stomach’s contents
can reflux (that is, back up into the esophagus), causing heartburn or gastroesophageal
reflux disease (GERD). When the upper esophageal sphincter does not completely close,
the stomach acid can flow out of the esophagus, results in laryngopharyngeal reflux
disease (LPRD). Unlike GERD, it often does not cause heartburn. Because the digestive
way and airway are next to each other, the stomach acid often leaks to the airway, causing
edema (swelling) of the posterior part of vocal folds. LPRD often causes voice disorders
without other digestive symptoms. For this reason, LPRD is called “silent reflux.” Individuals
with LPRD experience a hoarse voice in the morning, and the voice improves later in the
day. The management of GERD and LPRD includes the pharmacological approach,
behavioral modifications, and surgical treatment, depending on the degree of the problem

Aging and the...
Digestive System: From Appetite Suppression to Constipation
Age-related changes in the digestive system begin in the mouth and can affect virtually
every aspect of the digestive system. Taste buds become less sensitive, so food isn’t as
appetizing as it once was. A slice of pizza is a challenge, not a treat, when you have lost
teeth, your gums are diseased, and your salivary glands aren’t producing enough saliva.
Swallowing can be difficult, and ingested food moves slowly through the alimentary
canal because of reduced strength and tone of muscular tissue. Neurosensory feedback
is also dampened, slowing the transmission of messages that stimulate the release of
enzymes and hormones. Pathologies that affect the digestive organs—such as hiatal
hernia, gastritis, and peptic ulcer disease—can occur at greater frequencies as you age.
Problems in the small intestine may include duodenal ulcers, maldigestion, and
malabsorption. Problems in the large intestine include hemorrhoids, diverticular disease,
and constipation. Conditions that affect the function of accessory organs—and their
abilities to deliver pancreatic enzymes and bile to the small intestine—include jaundice,
acute pancreatitis, cirrhosis, and gallstones.

Physiology of Swallowing

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Deglutition

Swallowing is becoming a large component of the services Speech-Language Pathologists
provide to adult clients. In our fields, we describe the act of deglutition in four stages by
separating the voluntary phase into two separate steps. The descriptions below in black ink
are general information, and those in blue ink were added to provide information relevant to
Speech-Language Pathologists.

The Voluntary Phase (Oral Phase)

1a. Oral Preparatory phase

1b. Oral phase

The Pharyngeal Phase

The pharyngeal phase takes one second or less.
• This phase begins with the triggering of the swallow response or pharyngeal
response at the anterior facial pillars.
• The triggering of the swallow causes several physiologic activities to occur in the
pharynx simultaneously:
o Protection of nasal passage: velopharyngeal closure
o Protection of the airway: laryngeal elevation (superior and posterior or up and
back); inversion of the epiglottis; closure of aryepiglottic folds, false vocal folds,
and true vocal folds
o Facilitation of swallowing: Initiation of pharyngeal peristalsis to help bolus
moving from pharynx to esophagus.

Protection of nasal passage

Protection of the airway:

Facilitation of swallowing: Initiation of pharyngeal peristalsis to help bolus
moving from pharynx to esophagus. •
Access for free at openstax.org (Summarized, Rearranged, R

The Esophageal Phase
The entry of food into the esophagus marks the beginning of the esophageal phase of
deglutition and the initiation of peristalsis. As in the previous phase, the complex
neuromuscular actions are controlled by the medulla oblongata. Peristalsis propels the bolus
through the esophagus and toward the stomach. The circular muscle layer of the muscularis
contracts, pinching the esophageal wall and forcing the bolus forward. At the same time, the
longitudinal muscle layer of the muscularis also contracts, shortening this area and pushing
out its walls to receive the bolus. In this way, a series of contractions keep moving food
toward the stomach. When the bolus nears the stomach, distention of the esophagus
initiates a short reflex relaxation of the lower esophageal sphincter that allows the bolus to
pass into the stomach. During the esophageal phase, esophageal glands secrete mucus
that lubricates the bolus and minimizes friction. It is important to note that esophageal
dysphagia is not in the scope of practice of SLPs. In the event that esophageal dysphagia
is suspected, the evaluating SLP is expected to make a referral to a physician who
specializes in Gastrointestinal (GI) processes

The esophageal phase begins as the bolus enters the esophagus, and the bolus is
passed through into the stomach. Normal esophageal transit time is 8 to 20 seconds.
• When the bolus goes into the airway instead of the digestive way and stops at above the
vocal folds level, we call it penetration. When it passes the vocal folds and enters into
the lower airway, we call it aspiration. Aspiration pneumonia occurs when food or
liquid passes into the lungs and causes an infection.

Role of Speech-Language Pathologists in Swallowing

Oral Mechanism Examination
An oral mechanism examination (OME) is also referred to as "oral peripheral examination.
OME is one of the first and essential parts of a speech and language and/or swallowing
function evaluation following the chart or case history review. It allows the SLP to assess
the structures and functions of a client’s anatomy to determine if and why a disorder is
present. Ideally, your client or patient will be sitting up during this assessment, but in cases
where patients are medically fragile, this may not be the case. Let’s study how to administer
an OME for a patient during your initial evaluation.
In general, SLPs use the following materials for OME.
• Your OME procedure form: SLPs use various forms that are customized for their needs.
In our diagnostic lab today, we will use a published screening tool, Oral Speech
Mechanism Screening Examination (OSMSE)-3.
• Writing materials
• Hand sanitizer
• Gloves (appropriate size and material for you)
• Tongue depressors: two or three of them
• Small mirror
• Flashlight
• Metal spoon
• Two water bottles: One for your client and the other for a simple manometer test
• Clear plastic cup
• Two straws: One for your client, and the other for you to demonstrate the procedure.
• A box of tissue paper

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Communicating with Clients: Examples
To Adults
"I'm going to look at how the parts of your mouth move when you speak. This helps us
understand what might be making speech challenging for you. Everything I'll ask you to do
is simple and you will not experience pain."
To Children
"We're going to play a little game with our mouth and face! I will watch how your tongue,
lips, and cheeks move—like how superheroes stretch their muscles before a big
adventure! I'll ask you to make silly faces and move your tongue in funny ways. Are you
ready to play?"
The first step in administering an OME is to assess the exterior structures and function of
the body. You will ask yourself:
• How is the person’s posture? Are they slanted to one side or drooping forward?
• Is the face symmetrical? What about the lips? Are you noticing any drooping or
anything atypical? Do they have a closed mouth posture in a resting position?
• Is the person short of breath? Do they appear to be chunking their words into phrases
or single word utterances, or is their speech smooth and natural?

movement to see how the tongue can coordinate the movements from the anterior to
posterior directions. This trial can be completed by having the client repeat “puh tuh kuh”
as fast and accurately as possible until you stop. Check for fluidity in the production and
ability to move front-to-back with ease. Keep in mind that if your client is a child with an
articulation disorder, speech diadochokinetic test may be difficult, as they may not have
certain sounds in their inventory yet. In this case, the result may not reflect the difficulties
in coordination but rather an issue with producing the speech sound.
In a medical setting, you may proceed to check the swallowing function or complete a
cognitive-linguistic evaluation to assess cognition and language deficits. For our purposes,
it is important to check from the top down for any sort of explanation to the deficits. As you
develop your clinical skills, you will develop a procedure for completing an Oral Mechanism
Evaluation. There are some screening tool procedures available, such as the Mann
Assessment of Swallowing Ability, but often this procedure is based on clinical judgment and
is used to get an initial impression of the patient’s structures, function, and potential
explanations for deficits.

laryngopharynx

aspiration Pneumonia

deglutition

dysphagia

esophagus

esophageal phase

gastroesophageal reflux disease (GERD)

laryngopharyngeal reflux disease (LPRD)

laryngopharynx

oropharynx

oral mechanism examination (OME)

penetration

peristalsis

pharynx

pharyngeal phase

upper esophageal sphincter

voluntary phase

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The pharynx is divided into three major regions. They are
_______________, ____________, and _____________

2. [True/False] The pharynx is involved in both digestion and respiration. It receives food
and air from the mouth, and air from the nasal cavities. When food enters the pharynx,
involuntary muscle contractions close off the air passageways.

] ____________ creates involuntary wave-like motions of continuous
partial constriction and relaxation of the esophagus to propel the food to the stomach.

The act of chewing is called

] The act of swallowing is called

] When we swallow, we briefly cease breathing. It is called