CMD 525 - Dysphagia Midterm Pt. 2 (New Info) Exam 2022

(T/F) Carniofacial bones are mostly paired. - ANSWER True Nasal regurgitation - ANSWER Velum did not completely close off Lateral - ANSWER away from the midline Medial - ANSWER toward the midline Anterior - A ...

(T/F) Carniofacial bones are mostly paired. - ANSWER True Nasal regurgitation - ANSWER Velum did not completely close off Lateral - ANSWER away from the midline Medial - ANSWER toward the midline Anterior - ANSWER front Posterior - ANSWER back nasogastric tube - ANSWER tube inserted through the nose into the stomach PEG - ANSWER percutaneous endoscopic gastrostomy (T/F) The "V" of the vocal folds points to the front - ANSWER True Ventriclular space - ANSWER space between true vocal folds and false vocal folds vestibular space - ANSWER space between the false vocal folds and aryepiglottic folds subglottal space - ANSWER space below the true vocal folds supra glottal space - ANSWER space above the true vocal folds The epiglottis relies on the hyoid moving up and the tongue pushing down. - ANSWER hyolaryngeal excursion lingual aponeurosis - ANSWER tenden all muscles insert into wraps around - ANSWER mylohyoid What are the extrinsic muscles of the tongue? - ANSWER Genioglossus, styloglossus, palatoglossus, hyoglossus Which extrinsic muscle of the tongue can be seen in an oral-facial exam? - ANSWER palatoglossus bulk of the tongue - ANSWER genioglossus elongated - ANSWER styloglossus forms anterior faucial pillars - ANSWER palatoglossus broad, thin sheet - ANSWER hyoglossus What is the origin/insertion of the genioglossus? - ANSWER mental symphysis to hyoid What is the function of the genioglossus? - ANSWER protrudes, retracts, curl, depress What is the origin/insertion of the styloglossus? - ANSWER styloid process to tip of the tongue What is the function of the styloglossus? - ANSWER up, back, groove What is the origin/insertion of the palatoglossus? - ANSWER velum to lateral margins of the tongue (Lateral soft palate to lateral tongue - in front of the tonsils) What is the function of the palatoglossus? - ANSWER raises the back of the tongue and lowers the velum What is the origin/insertion of the hyoglossus? - ANSWER hyoid to posterior 1/2 of tongue What is the function of the hyoglossus? - ANSWER back and down (assess backwards c sound) lengthened vocal folds - ANSWER higher pitch (T/F) Laryngeal elevation is critical to protect the airway. - ANSWER True Suprahyoid - ANSWER laryngeal elevators What are the supra hyoid muscles? - ANSWER Digastric, stylohyoid, mylohyoid, geniohyoid, hyoglossus, genioglossus, styloglossus, palatoglossus What is the origin/insertion of the digastric? - ANSWER anterior belly: mandible to lessor horn of hyoid posterior belly: mastoid process to sternocleidomastoid What is the function of the digastric (CN V & CN VII)? - ANSWER depresses mandible; raises hyoid What is the origin and insertion of the stylohyoid? - ANSWER Styloid process to corpus of hyoid What is the function of the stylohyoid (CN VII)? - ANSWER pulls hyoid up and back What is the origin and insertion of the mylohyoid? - ANSWER Mandible - mental symphysis to last molar; midline raphe from mental symphysis to hyoid What is the function of the mylohyoid (V)? - ANSWER forms the floor of the mouth; elevates the larynx and depresses the mandible Where is the origin and insertion of the geniohyoid? - ANSWER mental symphysis to anterior surface of body of hyoid What is the function of the geniohyoid (C1, C2, XII)? - ANSWER pulls hyoid up and forward, critical to anterior movement What is the origin and insertion of the hyoglossus? - ANSWER corpus & greater horns of hyoid to posterior and lateral regions of tongue What are the functions of the hyoglossus (XII)? - ANSWER influences laryngeal position What is the origin and insertion of the genioglossus? - ANSWER mental symphysis to the body of the hyoid and under the surface of the tongue What is the function of the genioglossus (XII)?q - ANSWER elevates and pulls hyoid forward What is the origin and insertion of the styloglossus? - ANSWER styloid process to lateral tongue Where is the styloid process? - ANSWER temporal bone What is the function of the styloglossus (XII)? - ANSWER pulls up and back What is the origin and insertion of the palatoglossus? - ANSWER anterior velar surface to postero-lateral tongue What is the function of the palatoglossus (IX, X, XI)? - ANSWER narrows fauces, lower lateral velum, and elevates posterior tongue Are the supra hyoid muscles intrinsic or extrensic? - ANSWER extrensic Another name for infra hyoid muscles - ANSWER Strap Muscles Infrahyoid muscles are ______, _____, and _____. - ANSWER extrinsic, inferior, laryngeal depressors The infra hyoid muscles are innervated by _______. - ANSWER Spinal nerves C1-C3 What are the infrahyoid muscles? - ANSWER Sternohyoid, omohyoid, sternothyroid What is the origin and insertion of sternohyoid? - ANSWER mainly from the posterior side of the sternum (also the clavicle) to the lower border of the body of the hyoid What is the function of the sternohyoid? - ANSWER pulls hyoid down; fixes hyoid when mandible is depressed What is the origin and insertion of the omohyoid? - ANSWER Inferior/posterior belly: scapula to sternum Superior/Anterior belly: median tendon to greater horn of hyoid What is the function of the omohyoid? - ANSWER also important for respiration What is the origin and insertion of the sternothyroid? - ANSWER sternum and costal cartilage to oblique line of thyroid cartilage What is the function of the sternothyroid? - ANSWER pulls larynx down The Intrinsic laryngeal muscles are _____, ______, _____, and _____. - ANSWER inside the larynx, not attached to the hyoid, move the vocal folds, and innervated by the recurrent laryngeal nerve branch of vagus Cricothyroid is innervated by ______. - ANSWER Superior laryngeal branch of vagus What is the point of origin and insertion for the thryovocalis? - ANSWER thyroid angel to vocal process of arytenoid What is the point of origin and insertion for the thyromuscularis? - ANSWER thyroid angel to base of the arytenoids The thyrovocalis and thyromuscularis are ______. The thyrovocalis is _____ located and the thyromuscularis is ______ located. - ANSWER bilateral; medially; laterally What is the function of the thyrovocalis? - ANSWER tenses vocal folds What is the function of the thyromuscularis? - ANSWER relaxes vocal folds What are the intrinsic laryngeal muscles? - ANSWER thyrovocalis, thyromuscularis, posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, oblique arytenoid, cricothyroid muscle What is the origin and insertion for the posterior cricoarytenoid? - ANSWER posterior surface of cricoid lamina into the muscular process of arytenoids - lateral What is the function of the posterior cricoarytenoid? - ANSWER The ONLY abductor (open) What is the origin and insertion of the lateral cricoarytenoid? - ANSWER cricoid arch to muscular process of arytenoid What is the function of the lateral cricoarytenoid? - ANSWER ADDUCTOR; relaxes VF (Close) What is the origin and insertion of the transverse arytenoid? - ANSWER lateral & posterior margin of arytenoid to lateral and posterior margin of opposite arytenoid What is the function of the transverse arytenoid? - ANSWER adductor; slides arytenoids together What is the origin and insertion of the oblique arytenoid? - ANSWER base of one arytenoid to apex of the other arytenoid What is the function of the oblique arytenoid? - ANSWER adductor What are the vocal fold adductors? - ANSWER transverse arytenoid, oblique arytenoid, lateral cricoarytenoid What is the origin and insertion of the cricothyroid muscle? - ANSWER anterolateral arch of cricoid to pars oblique and pars recta What is the function of the cricothyroid muscle? - ANSWER tensor; elongates What is the firing sequence to close the vocal folds? - ANSWER Transvers arytenoids slide together, oblique arytenoids tilt, and lateral cricoarytenoids swivel shut Apex - ANSWER tip Pharyngeal branch of vagus innervates - ANSWER velum Branch of vagus that innervates (efferent) the cricothyroid - ANSWER external superior laryngeal branch of vagus Branch of vagus that receives sensation from the aditus to the true vocal folds? Is this penetration or aspiration? Is this sub glottal or supra glottal? - ANSWER Internal (afferent) superior laryngeal branch, penetration, supraglottal Which branch of vagus detects aspiration and receives sensory input for the larynx below the true vocal folds? - ANSWER superior recurrent laryngeal branch of vagus Which branch of vagus protects the airway by closing the vocal folds? - ANSWER Inferior branch of the recurrent laryngeal branch of vagus Innervates all other intrinsic laryngeal muscles (not the cricothyroid) - ANSWER Inferior branch of recurrent laryngeal branch of vagus What does the recurrent branch of vagus innervate? - ANSWER Thyrovocalis, Thyromuscularis, PCA, LCA, transverse arytenoid, oblique arytenoid These are toward the midline of the true vocal folds - ANSWER thyrovocalis What are the 3 layers of vocal folds? - ANSWER Aryepiglottic folds, false vocal folds, true vocal folds Where are the lips, tongue, and teeth located? - ANSWER oral cavity Where are the pharyngeal constrictors and valleculae? - ANSWER pharyngeal Where are the epiglottis, pyriform sinuses, false, and true vocal folds? - ANSWER laryngeal Where is the cricopharyngeal sphincter (AKA UES) - ANSWER ESOPHAGEAL opening between oropharynx and nasopharynx - ANSWER velopharyngeal port The ___ membrane covers the sub glottal space - ANSWER conus elasticus entrans and upper rim of the aryepiglottic folds; boundaries include the epiglottis, aryepiglottic folds, and apexes of the arytenoids - ANSWER aditus pear shaped - ANSWER piriform sinuses between the aryepiglottic folds and the thyroid cartilage; superiorly shallow; like gutters - ANSWER piriform sinuses divided horizontally and vertically - ANSWER spaces horizontal and vertical spaces are observed in _____. - ANSWER FEES vertical spaces are observed in ____. - ANSWER MBS Larygenal cavity - ANSWER aditus, piriform sinuses, vertical & horizontal spaces What are the vertical supra glottal spaces observed? - ANSWER aditus, vestibule, ventricular folds, ventricle, true vocal folds/glottis, sub glottal space space from aditus to false vocal folds - ANSWER vestibule false vocal folds - ANSWER ventricular folds space between ventricular and true vocal folds - ANSWER ventricle true vocal folds to cricoid lined with cilia that beat toward the pharynx - ANSWER subglottal What is is the horizontal space of the laryngeal cavity? - ANSWER Rimaglottidis: membranous glottis and cartilaginous glottis Anterior 3/5ths of true vocal folds - ANSWER membranous glottis posterior 2/5ths of the true vocal folds - ANSWER cartilaginous glottis Horizontal views of spaces are used for locating _____ on vocal folds. - ANSWER Growths What are the intrinsic laryngeal membranes? - ANSWER conus elasticus, quadrangular membrane from the cricoid arch to the true vocal folds ending in the vocal ligament - ANSWER conus elasticus also known as the cricovocal membrane - ANSWER conus elasticus from lateral margins of the epiglottis to the corniculate and arytenoid cartilages; inferiorly end in the ventricular ligament - ANSWER quadrangular membrane superior border to the epiglottis to apexes of the arytenoid cartilages; superior margin of quadrangular membrane - ANSWER aryepiglottic folds The aryepiglottic folds mark the opening the the ________, and ______ are embedded in these folds. - ANSWER laryngeal vestibule; cuneiform cartilages What are the phases of swallowing? - ANSWER 1. Oral Preparatory 2. Oral Transport 3. Pharyngeal 4. Esophageal salivation and mastication to form cohesive bolus - ANSWER Oral Preparatory tongue forms a groove/chute & pushes bolus posteriorly (positive pressure); swallow apnea/airflow inhibition, swallow reflex is triggered when the bolus reaches the valleculae - ANSWER Oral transport (T/F) Wherever the hyoid goes, the larynx goes. - ANSWER True -Begins when the bolus arrives at the level of the valleculae -Constriction of pharyngeal walls PUSHING bolus down -Adduction of true & false vocal folds (& aryepiglottic) -Elevation & anterior movement of hyoid & larynx - subsequently creates negative pressure in the hypopharynx (creates a suction from taking narrow space wide) -Epiglottic movement -opening of UES: traction from hood, relaxation from CN IX, and force of the bolus propulsion -Ends when the PES closes - ANSWER pharyngeal stage -peristalsis or rhythmic, sequential wavelike constrictions or contractions -elastic, muscular tube - 10 inches -inner circular fibers; outer longitudinal fibers -wave is strongest and fastest in cervical portion (upper) -secondary wave common with solid and semisolid boluses to assist in transport -2 sphincters: pharyngeal (PES or UES) and lower (LES) - ANSWER Esophageal What are the goals of each stage of swallowing? - ANSWER Oral Preparatory: Salivation & Mastication Oral Transport: Posterior movement of the bolus Pharyngeal: Airway protection & Esophageal Opening Esophageal: Peristalsis (Pushes the bolus from top to bottom) What are the 5 types of swallowing disorders? - ANSWER 1. Constricta 2. Lusoria 3. Oropharyngeal 4. Paralytical 5. Spastica narrowing of pharynx or esophagus - ANSWER constricta esophageal compression by right subclavian artery - ANSWER lusoria difficulty with propulsion from the mouth to the esophagus - ANSWER oropharyngeal paralysis of muscles of mouth, pharyngeal, or esophagus - ANSWER paralytical from spasm of pharynx or esophagus - ANSWER spastica What is the type of swallowing disorder that is typically most common? - ANSWER oropharyngeal an observation made by an examiner - ANSWER sign an observation felt or described by the patient - ANSWER symptom Clinical signs to determine at risk versus diagnosed with dysphagia - ANSWER nutrition, hydration, vital signs, respirator function, & swallow assessment What are the 4 main types of tx for dysphagia? - ANSWER 1. Behavioral: postures, strategies, etc. 2. Dietary: Texture, Taste, Volume 3. Medical: Medication; NG tube, chemo/radiation 4. Surgical: VF; PEG tube What are the 5 mechanisms of airway protection in the pharyngeal stage of swallowing? - ANSWER 1. cessation of active respiration 2. approximation of the true and false vocal folds 3. closure of the laryngeal aditus 4. deflection of bolus material by the tongue base over a rising larynx 5. division of the bolus through the valleculae that direct the bolus around the superior aspect of the airway entrance Description: Bulk Origin/Insertion: Mental symphysis to Hyoid Function: Protrudes, retracts, curl, depress - ANSWER genioglossus Description: Elongated Origin/Insertion: Styloid Process to Tip Function: Up, Back, Groove - ANSWER Styloglossus Description: Forms anterior faucial pillars Origin/Insertion: Velum to lateral margins of tongue (lateral soft palate - lateral tongue in front of tonsils) Function: Raises back of tongue & lowers velum - ANSWER palatoglossus Description: Broad, thin sheet Origin/Insertion: Hyoid to posterior 1/2 of tongue Function: Pulls back and down - ANSWER Hyoglossus Origin/Insertion: Anterior Belly - Mandible to lesser horn of hyoid Posterior Belly - Mastoid process to sternocleidomastoid Function: Anterior depresses mandible, posterior raises hyoid - ANSWER Digastric, CN V & VII Origin/Insertion: Styloid process to corpus of hyoid Function: Pulls hyoid up and back - ANSWER Stylohyoid, VII Origin/Insertion: Mandible - mental symphysis to last molar to the midline raphe from mental symphysis to hyoid Function: Forms the floor of the mouth; elevates larynx; depresses mandible - ANSWER Mylohyoid; V Origin/Insertion: Mental symphysis to anterior surface of body of hyoid Function: Pulls hyoid up and forward - ANSWER Geniohyoid; C1 & 2; XII Origin/Insertion: corpus & greater horns of hyoid to posterior lateral regions of the tongue Function: Influences laryngeal position - ANSWER Hyoglossus; XII Origin/Insertion: Mental symphysis to body of hyoid and under the surface of tongue Function: elevates and pulls hyoid forward - ANSWER Genioglossus; XII Origin/Insertion: styloid process to lateral tongue Function: pulls up and back - ANSWER styloglossus; XII Origin/Insertion: anterior velar surface to postero-lateral tongue Function: narrows fauces, lower lateral velum, and elevates posterior tongue - ANSWER Palatoglossus; IX, X, XI Origin/insertion: mainly from the posterior side of the sternum; also the clavicle to the lower border of the body of hyoid Function: pulls hyoid down; fixes hyoid when mandible is depressed - ANSWER Sternohyoid Origin/insertion: inferior or posterior belly: scapula to sternum; superior or anterior belly: median tendon to greater horn of hyoid Function: important for respiration - ANSWER Omohyoid origin/insertion: sternum and costal cartilage to oblique line of thyroid cartilage Function: pulls larynx down - ANSWER sternothyroid Origin/insertion: thyroid angle to vocal process of arytenoid function: tenses vocal folds - ANSWER thyrovocalis origin/insertion: thyroid angle to base of arytenoids function: relaxes vocal folds - ANSWER thyromuscularis origin/insertion: posterior surface of cricoid lamina to muscular process of arytenoids function: the ONLY ABDUCTOR - ANSWER posterior cricoarytenoid origin/insertion: cricoid arch to muscular process of arytenoid function: Adductor; relaxes vocal folds - ANSWER lateral cricoarytenoid (LCA) origin/insertion: lateral and posterior margin of arytenoid to lateral and posterior margin of opposite arytenoid function: adductor; slides arytenoids together - ANSWER transverse arytenoid origin/insertion: base of one arytenoid to apex of the other arytenoid function adductor (tilt) - ANSWER oblique arytenoid origin/insertion: anterolateral arch of cricoid to pars oblique and pars recta Function: tensor; elongates - ANSWER cricothyroid muscle Oral Preparatory Stage - ANSWER 1. Salivation & mastication to form cohesive bolus 2. Mastication under control of CN V -Masseter closes the jaw -Temporalis pulls jaw up, forward, and posteriorly -medial pterygoids work together to close & shift the jaw laterally -lateral pterygoids open & shift the jaw laterally 3. Buccinators assist in labial seal & move food across teeth - CN XII -Lingual muscles assist in shaping bolus Cranial Nerves: V, VII, & XII Oral Transport Phase: - ANSWER 1. Tongue forms a groove/chute & pushes bolus posteriorly 2. Intrinsic lingual muscles turn the lateral margins up 3. Intrinsic & extrinsic lingual muscles pull the tip & the back of the tongue up & back 4. Velar muscles seal off the nasal cavity and constrict nasopharynx Cranial Nerves: V, XII Important muscles: geniohyoid, mylohyoid, digastric Pharyngeal Stage of Swallowing - ANSWER 1. Constriction of pharyngeal walls via pharyngeal constrictors (X & XI) 2. Styloypharyngeus elevates pharynx (IX) 3. Salpingopharyngeus draws lateral pharyngeal wall up (XI & pharyngeal plexus) 4. Palatopharyngeus pulls velum down (X & XI) Intrinsic vocal fold muscles: adduction of true and false folds (RLN & SLN) 5. Suprahyoid muscles contract for elevation & anterior movement of hyoid & larynx 6. epiglottic movement - passive 7. Cricopharyngeus relaxes to facilitate the opening of the PES (X & Cervical ganglia) Cranial Nerves: IX, X, XI Esophageal phase of swallowing - ANSWER 1. peristalsis or rhythmic, sequential wavelike constrictions or contractions from PES to the LES -upper portions striated muscles -transitional area around aorta contains both striated and smooth muscle fibers -lower smooth muscle CN: X