Component

15: Tongue Base Retraction

Tongue base retraction is represented by posterior retraction of the tongue resulting in approximation of the
tongue base with the anteriorly displacing pharyngeal wall. Observations of tongue base retraction are made
based on the presence and degree of contrast or air present between these two structures. Tongue base
retraction is judged at the point of maximal retraction of the tongue base. In the case of the sequential
swallowing task, each swallow is considered in formulating the OI score.

Even if a nasogastric (NG) tube is present, continue to base judgements on the effectiveness of tongue base
retraction and the merging of the two structures: base of tongue to NG tube. Many times, the NG tube will
displace laterally and one is able to observe contact of the base of tongue to the posterior pharyngeal wall. In
either case, make your judgement about tongue base retraction based on the merging of whichever structure
(posterior pharyngeal wall or NG tube) approximates the base of tongue.


STRUCTURAL CONSIDERATIONS
Retraction of the tongue base results in a “merging” of the base
of tongue (BOT) with the posterior pharyngeal wall (PPW). These
structures are outlined in the image below. Maximal retraction
of the tongue base is easily determined by moving “frame-by-
frame” within the media player.


SCORING EXAMPLES
The following images are intended to help you differentiate between Tongue Base Retraction scores 0-4. The
base of tongue (BOT) is indicated in red and the posterior pharyngeal (PPW) wall in blue.

(0) No contrast or air between the BOT and PPW in the lateral viewing plane:
This resembles a “merging” of the BOT with the PPW.

(1) Trace column of contrast or air between the BOT and PPW:

“Trace” can resemble an outline made with a fine tip pen between the BOT and PPW or a small triangle created
by the glossoepiglottic ligament, BOT and PPW. The images below represent three variations of “trace”.

Similar to Components 1, 5 and 16 a score of 1 is a normal variant observation, and should not be considered
impairment when using Pharyngeal Total Sum scoring. It is maintained as a scored observation to train the user
to distinguish normal variation from a narrow column or space observed for a score of 2.

(2) Narrow column of contrast or air between the BOT and PPW:
This resembles an amount of air or contrast similar to “collection” (Components 5 and 16).

(3) Wide column of contrast or air between the BOT and PPW:

(4) No appreciable posterior motion of the BOT:
Despite initiating a swallow, the patient below demonstrates no appreciable posterior motion of the BOT. Be
careful to distinguish repetitive jaw motion from true posterior-ward tongue base movement.