Dysphagia Management in Head and

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Dysphagia
Management in
Head and Neck Cancers

A Manual and Atlas

Krishnakumar Thankappan
Subramania Iyer
Jayakumar R. Menon
Editors

123
Dysphagia Management
in Head and Neck Cancers
Krishnakumar Thankappan
Subramania Iyer • Jayakumar R. Menon
Editors

Dysphagia Management
in Head and Neck Cancers
A Manual and Atlas
Editors
Krishnakumar Thankappan Subramania Iyer
Department of Head and Neck Surgery Department of Head and Neck Surgery
and Oncology and Oncology
Amrita Institute of Medical Sciences Amrita Institute of Medical Sciences
Amrita Vishwa Vidyapeetham Amrita Vishwa Vidyapeetham
Kochi Kochi
India India

Jayakumar R. Menon
Department of Laryngology
Kerala Institute of Medical Sciences
Thiruvananthapuram and Dysphagia Unit
Amrita Institute of Medical Sciences
Amrita Vishwa Vidyapeetham
Kochi
India

ISBN 978-981-10-8281-8    ISBN 978-981-10-8282-5 (eBook)

https://doi.org/10.1007/978-981-10-8282-5

Library of Congress Control Number: 2018949613

© Springer Nature Singapore Pte Ltd. 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
To my loving parents Thankappan and Omana.
and Amrutha, Hemanth, and Sruthi for their unwavering
affection and support.
Krishnakumar Thankappan

To all my patients and trainees who keep on inspiring me.

Subramania Iyer

To my great teachers Professor S. Krishnamoorthy

and the late Professor N. Balakrishna Pillai.
Jayakumar R. Menon
Foreword

Dysphagia is an underrecognized sequela affecting both survival and quality

of life of more than half of the patients during their treatment for head and
neck cancers. Long-term results of the pivotal RTOG 91-11 trial that caused
a paradigm shift towards the nonsurgical management of head and neck can-
cers suggested aspiration and chronic dysphagia as the probable cause of
increased late deaths impacting survival. Similarly, Machtay analyzing three
chemoradiotherapy RTOG trials (91-11, 97-03, 99-14) for locally advanced
head and neck cancers found that over 40% of patients have late toxicity,
primarily related to speech and swallowing. Dysphagia is also a serious con-
cern following ablative surgery due to alteration in the anatomical structures
associated with swallowing. With oncologists focusing efforts at improve-
ment of survival, important factors such as dysphagia have been traditionally
overlooked and underreported. As a result, there has also been a paucity of
publications addressing this important issue. Dr. Iyer, Dr. Thankappan, and
Dr. Menon need to be congratulated for their efforts in bringing out this
monograph Dysphagia Management in Head and Neck Cancers. The book
has been astutely crafted into five sections, 33 chapters, providing a compre-
hensive coverage on the topic. In addition, the atlas including videos demon-
strating swallowing evaluation and management closely simulates a real-life
situation making it easier for the reader to assimilate. There is something in
the book for all those who treat head and neck cancers, namely the surgeon,
the radiation oncologist, and the speech and swallowing specialist. It makes
easy reading for beginners in the field as well as delves into the finer nuances
of the subject for the more seasoned clinician. This book fills a much-needed
void in the head and neck literature and is a must read for all in the field.

Anil K. D’Cruz
Tata Memorial Hospital
Mumbai, India

vii
Preface

The functional morbidity associated with the disease and its treatment has
been a stigma associated with head and neck cancers from time immemorial
to the present day. In the earlier ages, the versions of less sophisticated radia-
tion therapy, large defects caused by the surgery, and the inappropriate man-
agement protocols led to ghastly appearances and crippling functional
disability to the patients who survived the disease. The survival rate has
improved, and more patients with advanced stage disease can be cured now.
The advances in minimally invasive surgery, application of lasers and other
surgical tools, widespread use of microvascular reconstructive methods, and
development of precision radiotherapy have helped to decrease the morbidity
associated with the treatment of these cancers. But, with the quest for improv-
ing disease control, newer modalities of treatment and management protocols
are implemented. The morbidity associated with such regimens involving
advanced surgical resection and use of primary and adjunct chemoradiation
has thrown at us the challenges related to short-term and long-term morbidity.
Added to this is the increasing number of geriatric patients who get cured, but
have lesser ability to withstand the morbidity. Among the morbidity associ-
ated with the head and neck cancers and its treatment, dysphagia is the most
distressing one.
Dysphagia associated with head and neck cancers has been a poorly dis-
cussed topic till last decade. Not much attention was given to studying its
prevalence, fixing the etiological factors or implementing preventive and
therapeutic measures. But recent studies have shown that dysphagia if under-
stood and tackled well can improve the quality of life of these patients. Head
and neck cancers have numerous subsite differences in their behavior and
treatment. Dysphagia associated with cancers of the oral cavity and those of
the laryngopharynx is entirely different. Similarly, the dysphagia associated
with radiation and chemoradiation is different and needs a specialized
approach to tackle them. The management of dysphagia is to be started along
with the start of the treatment with many patients needing care for several
years after cure of the disease. This is carried out by a multidisciplinary team.
Dysphagia management needs to be appreciated and practiced by all mem-
bers of the team. In fact, a dedicated dysphagia management specialist has to
be an integral part of the head and neck cancer management team.
This book has been written with the purpose to impart insight into dyspha-
gia associated with head and neck cancers. The initial chapters deal with the
physiology of swallowing and pathophysiology of the dysphagia-related

ix
x Preface

structures. The assessment of dysphagia is discussed in detail with the empha-

sis being given to the clinical and instrumental evaluations. Features of dys-
phagia related to common subsite cancers are discussed individually.
Considering the fact that dysphagia associated with chemoradiotherapy is
being seen in an alarmingly increased manner, preventive measures both in
radiation therapy techniques and the institution of preventive swallowing
therapy measures have been given due importance. Direct and indirect swal-
lowing therapy methods involving postures and exercises are still an enigma
to the clinician. This has been dealt with in a detailed and simple manner to
enable them to be practiced routinely. Issues like nutritional management,
ways of alternate feeding, and special problems associated with tracheostomy
have a great bearing on the day-to-day management of the patients with dys-
phagia. All these issues are dealt with in separate chapters. Finally, the cur-
rent status of research and prospects is also included. The book is also
designed as an atlas including videos. Wherever appropriate, videos are
included for a better explanation of the subject.
This book is intended to be useful to all clinicians involved in head and
neck cancer management. Each chapter discusses the concerned issue in
detail, but for ease of practice, salient aspects are highlighted as pearls of
wisdom in each chapter. The book is also designed to be useful to the swal-
lowing therapists who intend to take the management of dysphagia associated
with head and neck cancers as part of their practice. Hopefully, this should
encourage more people to take up dysphagia management more passionately
and improve the quality of life of the head and neck cancer patients we treat
befitting to the current philosophy “Quantity of the cure is important, but
equally important is the quality of the cure.”

Kochi, India Krishnakumar Thankappan

 Subramania Iyer
 Jayakumar R. Menon
Acknowledgments

We would like to express our sincere gratitude to the Medical Director,

Principal, and the management of Amrita Institute of Medical Sciences,
Kochi, Kerala, India, for their support to make this book a reality. The fel-
lows, trainees, and staff of the Department of Head and Neck Surgery and
Oncology and the Division of Swallowing therapy have also helped
immensely. A special word of appreciation also goes to Drs. Deepak
Balasubramanian and Vidhyadharan Sivakumar for their help in the scientific
content. Bri. Abhirami, Mr. Dinesh, and other staff from the Department of
Graphics and Mr. Kishorkumar, Mr. Ajithkumar, and Mr. Rajiv from the
Department of Audio-Video Services of the institute also deserve special
mention for their help in the preparation of illustrations and videos. Mr. Sanoj
Viswam and Mr. Vivek volunteered as the models in the videos and that added
to the perfection of the book.

Krishnakumar Thankappan
Subramania Iyer
Jayakumar R. Menon

xi
Contents

Part I Anatomy and Physiology

1 Anatomy of Swallowing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Priyank V. Rathod, Sivakumar Vidhyadharan,
and Subramania Iyer
2 Physiology of Swallowing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Khyati Kamleshkumar Jani, Sivakumar Vidhyadharan, and
Subramania Iyer

Part II Evaluation

3 Pretreatment Counseling Education and Training. . . . . . . . . . . . 45

Sivakumar Vidhyadharan
4 Clinical Swallow Evaluation in Head and Neck Cancer. . . . . . . . 55
Brenda Capobres Villegas
5 Videofluoroscopy Swallow Study: Technique and Protocol. . .  67
Laishyang (Melody) Ouyoung
6 Flexible Endoscopic Evaluation of Swallowing (FEES):
Technique and Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Unnikrishnan K. Menon
7 Transnasal Esophagoscopy and Esophageal Manometry. . . . . . . 83
Jayakumar R. Menon and Ragitha Binu Krishnan
8 Scintigraphic Evaluation of Swallowing. . . . . . . . . . . . . . . . . . . . . 89
P. Shanmuga Sundaram and Padma Subramanyam

Part III Management Principles

9 Principles in the Management of Head and Neck Cancer . . . . . 103

Shreya Bhattacharya
10 General Principles in the Management of Dysphagia . . . . . . . . 111
Krishnakumar Thankappan, Anju Elsa Varghese,
and Mydhili Mayadevi

xiii
xiv Contents

11 Rehabilitative Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Mydhili Mayadevi and Krishnakumar Thankappan
12 Compensatory Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Anju Elsa Varghese and Krishnakumar Thankappan
13 Neuromuscular Electrical Stimulation (NMES) . . . . . . . . . . . . . 141
Krishnakumar Thankappan and Subramania Iyer
14 Phagosurgery: Surgical Management of Dysphagia. . . . . . . . . . 147
Jayakumar R. Menon, Manju E. Issac, Subramania Iyer, and
Krishnakumar Thankappan
15 Trismus in Head and Neck Cancer:
Causes and Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Adharsh Anand, Anil Mathew, and Deepak Balasubramanian
16 Diet and Nutritional Considerations. . . . . . . . . . . . . . . . . . . . . . . 173
Adharsh Anand and Deepak Balasubramanian
17 Tube Feeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Jayanthy Pavithran
18 Psychosocial and Quality of Life Issues in Dysphagia. . . . . . . . . 199
Sunitha Daniel
19 Aspiration and Related Complications. . . . . . . . . . . . . . . . . . . . . 211
Deepak Balasubramanian

Part IV Dysphagia Following Surgery

20 Dysphagia After Lip and Oral Cavity Surgery . . . . . . . . . . . . . . 221

Samskruthy P. Murthy, Krishnakumar Thankappan, and
Jayakumar R. Menon
21 Dysphagia After Oropharyngeal Surgery. . . . . . . . . . . . . . . . . . . 241
Samskruthi P. Murthy, Krishnakumar Thankappan, and
Subramania Iyer
22 Dysphagia After Laryngeal Surgery. . . . . . . . . . . . . . . . . . . . . . . 257
Narayana Subramaniam, Anju V. Nikitha,
and Krishnakumar Thankappan
23 Dysphagia After Hypopharyngeal Surgery . . . . . . . . . . . . . . . . . 277
Narayana Subramaniam, Arya C. Jaya,
and Jayakumar R. Menon
24 Cranial Nerve Palsy and Dysphagia. . . . . . . . . . . . . . . . . . . . . . . 287
Shashikant Vishnubhai Limbachiya,
Krishnakumar Thankappan, and Jayakumar R. Menon
25 Tracheostomy and Intubation-­Related Dysphagia . . . . . . . . . . . 297
Deepak Balasubramanian
Contents xv

Part V Dysphagia Following Radiotherapy/Chemoradiotherapy

26 Swallowing Dysfunction After Radiotherapy

and Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Prameela Chelakkot
27 Preventive Strategies in Radiation-­Associated
Dysphagia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Debnarayan Dutta and Krishnakumar Thankappan
28 Management of Dysphagia Following Radiotherapy . . . . . . . . . 333
Shashikant Vishnubhai Limbachiya, R. Anoop, and
Krishnakumar Thankappan
29 Mucositis: Prevention and Management . . . . . . . . . . . . . . . . . . . 349
R. Anoop
30 Pain Management During Radiotherapy
for Head and Neck Cancers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Charu Singh

Part VI Summary

31 Components of Swallow, Impairments, Causes, Observations,

and Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Krishnakumar Thankappan and Jayakumar R. Menon
32 Translational Research for Rehabilitation of Swallowing
in Head and Neck Cancer Patients. . . . . . . . . . . . . . . . . . . . . . . . 383
Uttam K. Sinha
33 Setting Up a Swallowing Clinic. . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Jayakumar R. Menon and Arya R. Raj
List of Contributors

Adharsh Anand Department of Head and Neck Surgery and Oncology,

Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
R. Anoop Department of Radiation Oncology, Amrita Institute of Medical
Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Deepak Balasubramanian Department of Head and Neck Surgery
and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
Shreya Bhattacharya Department of Surgical Oncology, Max Super
Speciality Hospital, Saket, New Delhi, India
Prameela Chelakkot Department of Radiation Oncology, Amrita Institute
of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Sunitha Daniel Department of Palliative Medicine, Amrita Institute of
Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Debnarayan Dutta Department of Radiation Oncology, Amrita Institute of
Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Manju E. Issac Department of Laryngology, Kerala Institute of Medical
Sciences, Thiruvananthapuram, Kerala, India
Subramania Iyer Department of Head and Neck Surgery and Oncology,
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
Khyati Kamleshkumar Jani Department of Head and Neck Surgery and
Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham,
Kochi, Kerala, India
Arya C. Jaya Department of Head and Neck Surgery and Oncology, Amrita
Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala,
India
Ragitha Binu Krishnan Department of Laryngology, Kerala Institute of
Medical Sciences, Thiruvananthapuram, Kerala, India

xvii
xviii List of Contributors

Shashikant Vishnubhai Limbachiya Department of Head and Neck

Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
Anil Mathew Department of Prosthodontics, Amrita School of Dentistry,
Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Mydhili Mayadevi Department of Head and Neck Surgery and Oncology,
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
Jayakumar R. Menon Department of Laryngology, Kerala Institute of
Medical Sciences, Thiruvananthapuram, Kerala, India
Dysphagia Unit, Department of Head and Neck Surgery, Amrita Institute of
Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Unnikrishnan K. Menon Department of ENT, Amrita Institute of Medical
Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala,
India
Samskruthi P. Murthy Department of Head and Neck Surgery
and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
Anju V. Nikitha Department of Head and Neck Surgery and Oncology,
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
Laishyang (Melody) Ouyoung Keck Medical Center, USC Caruso
Department of Otolaryngology-Head and Neck Surgery, University of
Southern California, Los Angeles, CA, USA
Jayanthy Pavithran Department of ENT, Amrita Institute of medical
Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Arya R. Raj Department of Laryngology, Kerala Institute of Medical
Sciences, Thiruvananthapuram, Kerala, India
Priyank V. Rathod Department of Head and Neck Surgery and Oncology,
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
P. Shanmuga Sundaram Department of Nuclear Medicine & Molecular
Imaging, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham,
Kochi, Kerala, India
Charu Singh Department of Palliative Medicine, Amrita Institute of Medical
Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Uttam K. Sinha Department of Head and Neck Surgery, Keck Medical
Center, University of Southern California, Los Angeles, CA, USA
Narayana Subramaniam Department of Head and Neck Surgery
and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
List of Contributors xix

Padma Subramanyam Department of Nuclear Medicine & Molecular

Imaging, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham,
Kochi, Kerala, India
Krishnakumar Thankappan Department of Head and Neck Surgery
and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
Anju Elsa Varghese Department of Head and Neck Surgery and Oncology,
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi,
Kerala, India
Sivakumar Vidhyadharan Department of Head and Neck Surgery
and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa
Vidyapeetham, Kochi, Kerala, India
Brenda Capobres Villegas Keck Medical Center, University of Southern
California, Los Angeles, CA, USA
USC Voice Center, USC Caruso Department of Otolaryngology-Head and
Neck Surgery, Los Angeles, CA, USA
About the Editors

Krishnakumar Thankappan is a professor in

the Department of Head and Neck Surgery and
Oncology at Amrita Institute of Medical Sciences,
Kochi, India. He completed his basic training in
Otolaryngology at BJ Medical College, Pune; his
MCh in Head and Neck Surgical Oncology at
Amrita Institute of Medical Sciences, Kochi; and
his advanced fellowship in Head and Neck
Oncology at Roswell Park Cancer Institute,
Buffalo, USA. He is the recipient of the Young
Investigator Award from the Indian Co-operative
Oncology network and has published more than
60 papers in international journals. He serves as a reviewer for several inter-
national journals and is the Regional Editor (Asia Pacific) for the Journal of
Cranio-Maxillary Trauma and Reconstruction. He has written a book titled
Basic Concepts in Head and Neck Surgery and Oncology.

Subramania Iyer graduated from the Medical

College, Kottayam, in 1979, before completing
his higher surgical training in Head and Neck
Surgery and Plastic Surgery from AIIMS, New
Delhi; Medical College, Calicut; and various cen-
ters in the United Kingdom. He did a fellowship
in Craniofacial Surgery at Mexico City, UICC; in
Laryngeal Cancer Surgery at Center Oscar
Lambret, Lille; and in Tissue Engineering at Rice
University, Houston. Currently, he is a professor
and head of the Division of Reconstructive
Surgery and Head and Neck Surgery/Oncology at the Amrita Institute of
Medical Sciences, Kochi. Dr. Iyer is the past president of the Foundation for
Head and Neck Oncology of India, secretary of the Indian Society of
Microsurgery, president of the Head and Neck Co-Operative research group,
member of the executive council of the Association of Plastic Surgeons of
India, and president of the Eurasian Association of Head and Neck Oncology.
He has written several international publications and serves as a reviewer for
many journals in the field of otolaryngology and plastic surgery.

xxi
xxii About the Editors

Jayakumar R. Menon is a consultant laryngol-

ogist at Kerala Institute of Medical Sciences,
Thiruvananthapuram and Dysphagia Clinic,
Amrita Institute of Medical Sciences, Kochi. He
trained in laryngology under John D Russell in
Dublin, Ireland. He is the founder vice president
and past president of the Association of
Phonosurgeons of India. He has given lectures,
orations, and keynote addresses in laryngology at
numerous state, national, and international con-
ferences. He has been an invited speaker at
numerous international conferences including the
last two World Voice Congresses and the World ENT Congress 2013 and
2017. He has contributed chapters in four international textbooks and pub-
lished several papers in national and international journals. He has also
described a clinical sign to diagnose abductor spasmodic dysphonia.
 Part I
Anatomy and Physiology
 Anatomy of Swallowing
1
Priyank V. Rathod, Sivakumar Vidhyadharan,
and Subramania Iyer

Introduction Oral Cavity

Swallowing is a complex function that involves
both volitional and reflexive activities. It involves
more than 30 nerves and muscles [1]. Swallowing
mechanism involves the oral cavity, oropharynx,
larynx, hypopharynx, and esophagus. It is a com-
plex process, and to understand the process, anat-
omy of swallowing is important.
The oral region, where the oral phase of swallow-
ing occurs, includes the lips, teeth, gums, cheeks,
oral cavity, soft palate, hard palate, and palatine
tonsils (Fig. 1.1). Processing the food and bolus
formation occur in the oral cavity. The lateral and
anterior limit is formed by the dental arches.
Superior limit is formed by the palate. The oral
tongue is inferior. Posteriorly, the oral cavity
changes into the oropharynx which is the supe-
rior part of the pharynx [2, 3].

P. V. Rathod · S. Vidhyadharan · S. Iyer (*)

Department of Head and Neck Surgery and
Oncology, Amrita Institute of Medical Sciences,
Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

© Springer Nature Singapore Pte Ltd. 2018 3

K. Thankappan et al. (eds.), Dysphagia Management in Head and Neck Cancers,
https://doi.org/10.1007/978-981-10-8282-5_1
4 P. V. Rathod et al.

Fig. 1.1 Oral cavity

and pharynx

Nasopharynx
Soft palate

Tongue
Oropharynx

Epiglottis

Hypopharynx

Arytenoid

Vocal cords (false)

Vocal cords (True)

Cricoid cartilage

Trachea
1 Anatomy of Swallowing
Structures Within Oral Cavity
Lips
The lips are musculofibrous mobile folds sur-
rounding the mouth. They extend from the naso-
labial sulci and nares laterally and superiorly to
the mentolabial sulcus inferiorly. The lips contain
the orbicularis oris, superior and inferior labial
muscles, the vessels, and the nerves and also con-
tain labial vessels, nerves, minor salivary glands,
and fatty tissue. The lips are covered outside by
the skin and inside by the mucous membrane.
The lips act as valves of oral cavity. The orbicu-
laris oris acts as the sphincter that controls the
entry and exit of the bolus from the mouth and
upper alimentary and respiratory tracts. Closure of
oral commissure is most important to prevent
food, liquid, or saliva from drooling out of the
mouth, the orbicularis oris muscle which is respon-
sible for this function. The lips are used for grasp-
ing food, sucking liquids, keeping food out of the
vestibule, forming speech, and osculation [4].
 heeks and Buccal Mucosa
C the tongue to the epiglottis. The vallecula is the
The cheeks constitute the lateral boundary of the
oral cavity. They continue as the lips. They are
formed by the buccinator muscles and the buccal
fat pads. The fat pads are superficial to the buc-
cinators. Buccal mucosa and the deeper buccina-
tor muscle provide enough force and modification
to the tongue to prepare a bolus and push it medi-
ally to the teeth and tongue [5].
Teeth
The teeth play a significant part in mastication.
They are placed in the socket of mandible and max-
illa. The teeth, socket, and bone are covered by
mucosa which is known as gingival mucosa.
Humans have two types of teeth, namely, the decid-
uous and the permanent teeth. The 20 deciduous
teeth include 2 incisors, 1 canine, and 2 molars in
each half of the upper and lower dentition. In
adults, they get replaced by the permanent teeth.
The alveoli move forward to occupy the molars,
which erupt behind the premolars. There are four
sets of eight permanent teeth in the fully developed
alveolus. Teeth are responsible for chewing, for bit-
ing, and for grinding. Teeth are responsible for pul-
verizing the food and bolus formation [5].
5
Tongue
It is a mobile structure made of muscles, situated
in the floor of the mouth, that sits in the oral cavity
and in the oropharynx (Fig. 1.2) [2, 3]. It is an
important organ for deglutition, taste, and speech.
It has oral and pharyngeal parts and is attached to
the hyoid bone, mandible, styloid processes, soft
palate, and pharyngeal wall by its muscles. A
median septum divides the tongue into two halves.
Each half contains paired intrinsic and extrinsic
components. Intrinsic muscle fibers are arranged
in an interlacing pattern of longitudinal, trans-
verse, vertical, and horizontal fascicule. The intrin-
sic muscles, the superior and inferior longitudinal,
transverse, and vertical parts, originate from the
tongue and insert to the tongue ­substance (Fig. 1.3).
The extrinsic muscles, ­genioglossus, hyoglossus,
styloglossus, and palatoglossus, originate from
structures outside the tongue and insert in the
tongue substance (Fig. 1.4). The attachments,
function, and innervation of the muscles of the
tongue are depicted in Table 1.1. The median and
lateral glossoepiglottic folds connect the base of
space in between the median and lateral folds on
both sides. The mandibular attachment is provided
by the genioglossus. The attachment to the hyoid
is provided by the hyoglossus. Styloid process is
by the styloglossus and to the palate is by the pala-
toglossus muscle. The extrinsic muscles bring
about protrusion, retraction, depression, and eleva-
tion of the tongue. The intrinsic muscles change
the tongue shape. They lenghthen, shorten, curl,
and uncurl its sides and apex, flatten and round its
surface. This helps in the fine tongue movements
[3, 5].
The sensation of the tongue shows its embry-
ological development. The anterior two-thirds
are derived from first-arch mesenchyme and the
posterior third from third-arch mesenchyme.
The general sensation to the anterior two-thirds
is carried by the lingual nerve. This also carries
taste sensation derived from the chorda tympani
branch arising from the facial nerve. The gen-
eral sensation and taste to the posterior third is
provided by the glossopharyngeal nerve. An
area in the region of the valleculae is supplied
by the internal laryngeal division of the vagus
nerve [5].
6 P. V. Rathod et al.

Epiglottis

Lingual tonsils
Posterior 1/3rd
Palatine tonsil

Terminal sulcus

Vallate papillae

Foliate papillae

Fungiform papillae

Anterior 2/3rd

Fig. 1.2 Tongue, dorsal view

Superior longitudinal muscle

Vertical and transverse muscles

Inferior longitudinal muscle

Styloglossus muscle

Hyoglossus muscle

Sublingual salivary gland

Lingual artery

Facial vein
Fig. 1.3 Coronal
Mylohyoid muscle
section of intrinsic
muscles of the tongue Hyoid bone
1 Anatomy of Swallowing 7

Dorsum of tongue

Palatoglossus

Tip of tongue
Styloid Process

Styloglossus

Hyoglossus
Mandible
Hyoid bone

Genioglossus
Geniohyoid

Mylohyoid

Fig. 1.4 Extrinsic muscles of the tongue

Table 1.1 Muscles of the tongue [4, 6, 7]

Muscles of the tongue Cranial nerve supply Main action
Intrinsic Superior Hypoglossal nerve Elevates tongue tip and lateral border, shortens the tongue
longitudinal
Inferior Hypoglossal nerve Depresses tongue tip down, shortens the tongue
longitudinal
Transverse Hypoglossal nerve Elongates and narrows the tongue
Verticalis Hypoglossal nerve Widens and flattens the tongue
Extrinsic Genioglossus Hypoglossal nerve Protrusion of the tongue, depresses the central part of the
tongue
Hyoglossus Hypoglossal nerve Retrudes and depresses the tongue
Styloglossus Hypoglossal nerve Retracts and elevates the tongue
Palatoglossus Pharyngeal plexus Elevates the posterior part of the tongue, depresses the soft
(pharyngeal branch palate. It moves palatoglossal fold toward the midline
of vagus)
8 P. V. Rathod et al.
Hard Palate
The bone of the hard palate is formed by the
palatine processes of the maxillae and the hori-
zontal plates of the palatine bones. It is bounded
in front and at the sides by the alveolus of the
upper jaw with the teeth and is continuous poste-
riorly with the soft palate (Fig. 1.5). It is covered
by a thick mucosa bound tightly to the under-
Palatine aponeurosis
(from tensor veli palatin muscle
Uvular muscle
Palatopharyngeus muscle
Palattine tonsil
Levator veli palatini muscle (cut)
Tensor veli palantini muscle
Medial pterygoid muscle (cut)
Medial pterygoid plate
Pterygold hamulus
Tendon of tensor veli palatini muscle
Levator veli palatini muscle (cut)
Palatopharyngeus muscle (cut)
Uvular muscle
Fig. 1.5 Roof of oral cavity and muscles of oropharynx
lying periosteum. The mucosa is covered by
keratinized stratified squamous epithelium. The
submucosa in the posterior half of the hard pal-
ate contains minor mucous-type salivary glands.
The sensory supply of the hard palate is the
greater palatine and ­nasopalatine branches of the
maxillary nerve. They pass through the pterygo-
palatine ganglion [3].
Greater palatine formen
Tendon of tensor veli palatini muscle
Pterygoid hamulus
Buccinator muscle
Pterygomandibular raphe
Superior pharyngeal constrictor muscle
Palatoglossus muscle
Basilar part of occipital bone
Cartilaginous part of pharyngotympanic
(eistachian) tube
Pharyngobasilar fascia
Levator veli palatini muscle
Choanae
Pterygoid hamulus
Superior pharyngeal constrictor muscle (cut)
1 Anatomy of Swallowing 9

Soft Palate the pharynx. It is bound superiorly by the soft pal-

It provides the separation of the nasopharynx from
the oropharynx. Though soft palate subsite wise
belongs to the oropharynx, it is described here. It
has a lining by mucous membrane. The compo-
nents are the palatine aponeurosis, the tensor veli
palatini, mucous glands, muscles, and taste buds.
The palatine aponeurosis is divided to enclose the
musculus uvulae to form the uvula (Fig. 1.5). The
soft palate contacts with Passavant’s ridge, on
elevation, thus closing the isthmus of the pharynx
during the swallow. This provides separation of
the nasopharynx from the oropharynx and pre-
vents nasal regurgitation. Soft palate depression
closes the oropharyngeal isthmus. It is suspended
from the posterior border of the hard palate by the
palatine aponeurosis, anteriorly [8]. The uvula
hangs from a curved free margin, posteriorly and
inferiorly. Laterally, it continues with the palato-
glossal and the palatopharyngeal arches, which
join it to the tongue and the pharynx, respectively
[8, 9]. The fauces lies between the oral cavity and
ate, laterally by the palatoglossus and the pala-
topharyngeal arches, and inferiorly by the base
of the tongue. Table 1.2 gives a summary of the
muscles of the soft palate.
The general sensation from most of the soft
palate is carried by branches of the lesser palatine
nerve, a maxillary nerve branch, and from the
posterior part of the palate by pharyngeal
branches from the glossopharyngeal nerve and
the plexus around the tonsil formed by tonsillar
branches of the glossopharyngeal and lesser pala-
tine nerves. The taste sensation from taste buds in
the oral surface of the soft palate is carried in the
lesser palatine nerve. The taste fibers initially
travel in the greater petrosal nerve, a branch of
the facial nerve, and pass through the pterygo-
palatine ganglion without synapsing. The lesser
palatine nerve also carries the secretomotor sup-
ply to most of the mucosa of the soft palate, via
postganglionic branches from the pterygopala-
tine ganglion [3].

Table 1.2 Muscles of the palate [4, 6, 7]

Muscles of the
palate Cranial nerve supply Main action
Levator veli Pharyngeal plexus (pharyngeal branch of vagus Elevates soft palate beyond neutral position
palatini and glossopharyngeal nerves)
Tensor veli Trigeminal nerve (medial pterygoid nerve, a Stiffens the soft palate, opens Eustachian
palatini branch of the mandibular nerve via otic tube for pressure equalization
ganglion)
Palatoglossus Pharyngeal plexus (pharyngeal branch of vagus Depresses the soft palate.
and glossopharyngeal nerves) Moves palatoglossal arch toward the
midline and elevates posterior part of the
tongue
Palatopharyngeus Pharyngeal plexus (pharyngeal branch of vagus Depresses the soft palate.
and glossopharyngeal nerves) Moves palatopharyngeal arch to the midline
and elevates the pharynx
Musculus uvulae Pharyngeal plexus (pharyngeal branch of vagus Elevates and retracts the uvula. Thickens
and glossopharyngeal nerves) the central part of the soft palate
10 P. V. Rathod et al.

Muscles of Mastication cisely to enable different speech sounds that are to be

They move the mandible during mastication, speech,
and deglutition. They can exert enormous forces that
are required to break down tough food into particles,
and they also move the mandible quickly and pre-
made in rapid succession. The main muscles of mas-
tication are the masseter, temporalis, lateral ptery-
goid, and medial pterygoid (Figs. 1.6 and 1.7)
(Table 1.3). The secondary muscles of mastication
are the suprahyoid and infrahyoid muscles [4].

Fig. 1.6 Muscle of Temporalis muscle

mastication, lateral view

Deep part Masseter

Superficial part muscle

Buccinator muscle

Lateral pterygoid muscle

(superior and inferior heads)

Medial pterygoid muscle

Buccinator muscle

Pterygomandibular raphe

Superior pharyngeal constrictor muscle

Lateral pterygoid plate

Temporomandibular joint

Lateral pterygoid muscle

(superior and inferior heads)

Medial pterygoid muscie

Medial pterygoid muscle Tensor veli palatini muscle (cut)

Medial pterygoid plate Levator veli palatini muscle (cut)

Pterygoid hamulus Pterygoid hamulus

Nerve to mylohyoid

Fig. 1.7 Muscle of mastication, posterior view

1 Anatomy of Swallowing
Table 1.3 Muscles of the mastication [4, 6, 7]
Muscles of mastication
Jaw opening muscles Anterior belly of digastric
Posterior belly of digastric
Lateral pterygoid
Mylohyoid
Geniohyoid
Jaw closing muscles Temporalis
Medial pterygoid
Masseter
11
Cranial nerve supply Main action
Trigeminal nerve Elevates hyoid bone
(via anterior trunk of
mandibular nerve)
Facial nerve Elevates hyoid bone
Trigeminal nerve Depresses and protrudes
(anterior trunk of mandible. Lateral rotatory
mandibular nerve) movement of the mandible
Trigeminal nerve Elevates hyoid bone, lowers
(via anterior trunk of the mandible
mandibular nerve)
Ansa cervicalis (C1) Elevates the hyoid bone,
and hypoglossal lowers the mandible
Trigeminal nerve Elevation and retraction of the
(via anterior trunk of mandible, movements of the
mandibular nerve) mandible side to side
Trigeminal nerve Elevation and movement of the
(via anterior trunk of mandible side to side, assists
mandibular nerve) lateral pterygoid in protrusion
of the mandible
Trigeminal nerve Elevation of the mandible
(via anterior trunk of
mandibular nerve)
12 P. V. Rathod et al.

Larynx Cartilages of the Larynx

The laryngeal framework is formed by cartilages The unpaired cartilages are the cricoid, thyroid,
connected by membranes and ligaments. The and epiglottis, whereas the paired cartilages are
extrinsic and intrinsic muscles of the larynx move corniculate, cuneiform and the arytenoids
the framework. During deglutition, the larynx (Fig. 1.8).
must shut to prevent aspiration of food into the
airway. This is achieved by raising the larynx to
the base of the tongue, the vocal fold closure, and
the closure of the epiglottis over the laryngeal
vestibule.

Superior horn of thyroid cartilage

Corniculate cartilage

Arytenoid cartilage

Thyroid catilage lamina

Inferior horn of thyroid catilage

Cricoid cartilage

Trachea

Anterior view Posterior view

Epiglottis Corniculate
cartilage
Hyoid bone Arytenoid
articular
Corniculate cartilage
surface Muscular
Arytenoid cartilage Cricoid
cartilage process Arytenoid
Muscular process Lamina cartilage
Vocal
Vocal process process
Arch
Vocal ligament
Thyro-epigiottic ligment
Anterosuperior view
Cricoid catilage

Trachea

Right lateral view Medial view, median (sagittal) section

Fig. 1.8 Cartilages of larynx

1 Anatomy of Swallowing
Thyroid Cartilage
This is the longest among the laryngeal cartilages
and has two laminae that meet in the midline in
the lower aspect, with a palpable notch, the thy-
roid notch, between them in the upper aspect.
This laryngeal prominence is visible more in men
because the angle between the laminae is acute in
men (90°) than in women (120°).
The two laminae have a quadrilateral shape
and form the lateral surfaces. They extend
obliquely to cover the trachea on each side. The
posterior aspect of each lamina is extended
upward and downward to form a superior and
inferior horn. The inside of the inferior horns
articulates with the outer posterolateral surface of
the cricoid cartilage. The outer surface of each
lamina has an oblique line that curves downward
and forward. The line extends from the superior
thyroid tubercle to the inferior thyroid tubercle,
situated on the lower rim. The thyrohyoid, ster-
nothyroid, and inferior constrictor muscles get
attached to this line. The inside of the laminae is
covered by a mucous membrane.
The lower border is attached to the cricoid car-
tilage by the cricothyroid membrane in center
and the cricothyroid muscles on either side. The
thyrohyoid membrane spans between the supe-
rior horn and the superior border of the thyroid
cartilage to the hyoid bone [2, 10].
Cricoid Cartilage
The cartilage is placed at the lower part of the
larynx. It is the only complete ring of the carti-
lage in the trachea. Similar to the signet ring, it is
broad posteriorly to form the lamina of the cri-
coid cartilage and a narrow anteriorly, the arch.
The posterior surface of the lamina has two
depressions oval in shape. These serve as the
attachment for the posterior cricoarytenoid mus-
cles. They are separated by a midline by a vertical
ridge giving the attachment to the esophagus.
Small articular facets exist on the outer postero-
lateral surface of each side that articulate with the
inferior horn of the thyroid cartilage, at the junc-
tion of the lamina with the arch. The ­cricotracheal
ligament provides connection for the inferior
border of the cricoid cartilage to the first tracheal
ring. The superior border of the cricoid gives
13
attachment to the cricothyroid ligament on the
midline anteriorly, the cricothyroid muscles lat-
erally, and a pair of arytenoid cartilages on both
sides posteriorly [10, 11].
Epiglottis
It is a flexible, cartilaginous structure, heart
shaped covered by mucosa that lies behind the
base of the tongue and hyoid and in front of the
laryngeal inlet. It forms a lid over the larynx and
protects it from aspiration. It gets attachment to
the midline of the inner aspect of the thyroid car-
tilage. It has a narrow stem that is attached to the
angle between the thyroid laminae by the thyro-
epiglottic ligament, below the thyroid notch. The
broad upper part is facing upward and backward,
and it has a free superior margin.
The anterior surface of the epiglottis is free
and is covered with mucosa. This gets reflected
on to the pharyngeal part of the base of the tongue
and the lateral wall of the pharynx, forming a
median glossoepiglottic and two lateral glosso-
epiglottic folds. The depression on each side of
the median glossoepiglottic fold is the vallecula.
The mucosal folds on the posterior surface of the
epiglottis are the aryepiglottic folds. The hyoepi-
glottic ligament forms the connection between
the inferior part of the epiglottis and the hyoid
bone. The space between the epiglottis and the
thyrohyoid membrane is the preepiglottic space
and is filled with fatty tissue.
Fibroelastic ligaments fix the epiglottis to the
hyoid, thyroid cartilage, and quadrangular mem-
brane. When the larynx is elevated and hyoid is
approximated to the thyroid, the suspended epi-
glottis shifts from a vertical to a horizontal orien-
tation over the laryngeal vestibule 3, 5, 7. Once it
is horizontal, compression by the advancing
bolus, peristalsis by the pharyngeal constrictors,
and the contraction of thyroepiglottic muscle
complete the closure of the epiglottis over the
laryngeal inlet 3, 7.
Arytenoid Cartilages
The arytenoid cartilages give attachment to the
vocal ligaments and vocal folds. They have a
pyramidal shape with three surfaces, a base, and
an apex. They are placed superior to the cricoid
Another random document with
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The Project Gutenberg eBook of Studiën in
Nederlandsche Namenkunde
 This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
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Title: Studiën in Nederlandsche Namenkunde

Author: Johan Winkler

Release date: September 19, 2023 [eBook #71689]

Language: Dutch

Original publication: Haarlem: H. D. Tjeenk Willink & Zoon, 1900

Credits: Jeroen Hellingman and the Online Distributed

Proofreading Team at https://www.pgdp.net/ for Project
Gutenberg (This file was produced from images
generously made available by The Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK STUDIËN IN

NEDERLANDSCHE NAMENKUNDE ***
[Inhoud]

[Inhoud]

Studiën in Nederlandsche Namenkunde.

[Inhoud]
 STUDIËN
IN
NEDERLANDSCHE
NAMENKUNDE

DOOR
JOHAN WINKLER.
 HAARLEM
H. D. TJEENK WILLINK & ZOON
1900

[Inhoud]
Boeck, ey soo men di wil laecken,
Segg’ dat si yet beters maecken.
Laecken end maecken is groet verscil,
Dye nyet en can maecken magh swigen still.

D’æbarre traeppet plomp yn ’t gnod,

Oer ’t goe kruwd hinne in sykt de Podd’.
Dy hier uwt naet az fuwl op-syckje,
Momme eack, mey rjuecht, by Rea-schonck
lyckje.

Gysbert Japicx.

Wy willen gheerne ’t onse om een beter gheven,

Isser iet ghefaelt, tsy groot oft cleene.
Maer qualick can ment elck te passe gheweven:
Want niemant volmaeckt, dan God alleene.

Marcus van Vaernewyck.

[Inhoud]
 INHOUD.

Bladz.
Inleiding
I. Spotnamen van steden en dorpen 3
II. Nederlandsche plaatsnamen in Frankrijk 91
III. Gentsche geslachtsnamen 136
IV. Helmondsche namen uit de middeleeuwen 171
V. Friesche namen 196
VI. De namen der ingezetenen van Leeuwarden ten
jare 1511 255
VII. De hel in Friesland 280
Register 293

[1]

[Inhoud]
 INLEIDING.

De Namenkunde vormt een belangrijk onderdeel van de Taalkunde

in haren grootsten omvang, en staat tevens in menigvuldige
betrekking tot Geschiedenis en Volkenkunde.

De kennis van de namen in ’t algemeen, wat hun oorsprong,

geschiedenis en beteekenis aangaat, is inderdaad een zeer
bijzonder vak van wetenschap, een tak van studie die mij steeds
bijzonder heeft aangetrokken, en die bij voorkeur door mij beoefend
is geworden. Herhaaldelijk heb ik dan ook het een en ander werk of
werkje geschreven en in ’t licht doen komen, dat de Namenkunde
van Nederland (plaatsnamen) en van Nederlanders (vóórnamen en
geslachtsnamen) in bijzondere onderdeelen behandelt. Ik behoef
hier slechts mijn werk De Nederlandsche Geslachtsnamen in
Oorsprong, Geschiedenis en Beteekenis 📘 (Haarlem, H. D. Tjeenk
Willink, 1885) te noemen en mijne Friesche Naamlijst (Leeuwarden,
Meyer en Schaafsma, 1898), twee uitgebreide, omvangrijke werken,
die mij veel moeitevolle studie hebben gekost, maar die mij evenzeer
veelvuldige voldoening hebben bereid. Buitendien is er nog in
tijdschriften en jaarboekjes 1 menig opstel van mijne hand
verschenen, dat het een of ander gedeelte der Namenkunde tot
onderwerp heeft, dat Nederlandsche namen uit verschillende
tijdperken van ons volksbestaan, en uit verschillende gouwen en
plaatsen behandelt. [2]

Een zestal van die verhandelingen, uit den aard der zaak weinig
bekend, heb ik uitgekozen, en, ten deele aangevuld, vermeerderd,
verbeterd, hier opnieuw doen afdrukken. Een grooter opstel, over de
Spotnamen van steden en dorpen, het hoofdnummer van dezen
bundel, heb ik daarbij gevoegd. Dat verschijnt hier voor ’t eerst in ’t
licht.

Deze verschillende verhandelingen hangen slechts los te zamen;

slechts in zooverre als ze allen een onderwerp van Namenkunde
behandelen. Overigens niet.

Millioenen namen, mans- en vrouwen-vóórnamen in honderderlei

vormen en vervormingen, oorspronkelijk volkseigene en vreemde,
zoowel als geslachts- en plaatsnamen, eveneens in honderderlei
vormen, en die voor een groot deel van die vóórnamen zijn afgeleid
—inderdaad millioenen namen zijn over alle Nederlanden verspreid,
bij het Nederlandsche volk in gebruik. Elke naam heeft zijnen
eigenen, bijzonderen oorsprong, zijne geschiedenis, zijne
beteekenis, en zeer vele namen zijn in hunnen oorsprong, in hunne
geschiedenis en beteekenis belangrijk en merkwaardig. Elke naam
kan met andere soortgelijke in verschillende groepen vereenigd
worden, en al die namengroepen afzonderlijk in wetenschappelijken
zin beoefend en behandeld worden. Welk een arbeidsveld! En, voor
zooveel het onze Nederlandsche namen betreft, is dat veld nog zoo
weinig ontgonnen!

Ik heb slechts hier en daar een greep kunnen doen in deze rijke stof,
die zoo ruimschoots voorhanden, en voor iedereen toegankelijk is;
slechts hier en daar een greep ter verklaring van sommige
namengroepen en namen.

Mogen de volgende studiën, die uit den aard der zaak slechts in zeer
beperkten en beknopten vorm sommige namengroepen behandelen,
den lezer welkom zijn, en zijne belangstelling opwekken! En mogen
velen, door de lezing en de beoefening dezer verhandelingen zich
aangespoord gevoelen om al mede aan dit onderwerp, aan de
Namenkunde, hunne krachten te wijden; en moge onze
vaderlandsche wetenschap daardoor grootelijks verrijkt en gebaat
worden!

Den vriendelijken lezer een vriendelijke groet van

Johan Winkler.

H a a r l e m , 1900. [3]

1 De Navorscher, De Vrije Fries (tijdschrift van het Friesch Genootschap voor

Geschied-, Oudheid- en Taalkunde, Leeuwarden), Rond den Heerd (Brugge),
Ostfriesisches Monatsblatt (Emden), Nomina Geographica Neerlandica (tijdschrift
van het Nederlandsch Aardrijkskundig Genootschap), Belfort (Gent), de Friesche
Volksalmanak (Leeuwarden), de Noordbrabantsche Almanak (Helmond), enz. ↑
[Inhoud]
I
 SPOTNAMEN VAN STEDEN EN DORPEN.

Onderscheid in geaardheid, onderscheid in volkseigene zaken, taal

en tongval, kleeding, zeden en gebruiken, nering en bedrijf bij zee-,
steê- en landvolk, onderscheid in richting en partijschap op
godsdienstig en op staatkundig en maatschappelijk gebied is er
heden ten dage in ons vaderland nog ruimschoots voorhanden,
tusschen de bevolking van het eene en van het andere gewest, van
de verschillende Nederlandsche gewesten onderling.
Niettegenstaande dit onderscheid langzamerhand al minder en
minder wordt, en gedurig uitslijt, vooral door het meerdere en
gemakkelijke verkeer tusschen de lieden uit de verschillende
gewesten van ons land onderling, zoo onderkent men toch den Fries
aan allerlei volkseigene en bijzonder Friesche zaken en
eigenaardigheden nog gemakkelijk uit alle andere Nederlanders.
Maar ook de Groningerlander en de Zeeuw, de Hollander en de
Gelderschman, de Overijsselaar en de Brabander, de Drent en de
Limburger, ja ook de Hollander uit het Noorden (West-Friesland) en
die uit het Zuiden (het Overmaassche) zijn voor den opmerkzamen
man duidelijk en gemakkelijk te kennen, duidelijk en gemakkelijk de
een van den ander te onderscheiden.

Oudtijds traden de kenteekenen die den Fries en den Brabander,

den Gelderschman en den Hollander, den Drent en den Zeeuw
onderscheiden, veel sterker te voorschijn dan heden ten dage. Ja,
allerlei bijzondere kenmerken waren zelfs op te merken [4]bij de
bewoners van verschillende steden en dorpen—kenmerken,
waardoor dezen zich onderscheidden van de ingezetenen van
andere, van naburige of ook van verderaf gelegene plaatsen. Het
onderscheid tusschen de bewoners van twee naburige plaatsen, al
waren die lieden dan ook oorspronkelijk van geheel den zelfden
volksstam, viel juist hen onderling, over en weêr, bijzonder in ’t oog,
klonk juist te duidelijker in hun oor, werd juist door hen te scherper
opgemerkt. Voor den Hollander moge er geen onderscheid zijn te
bespeuren, in spraak noch in voorkomen, noch in eenigerlei andere
volkseigene zaak tusschen eenen burgerman uit Leeuwarden en
eenen uit Dokkum, voor den Leeuwarder en den Dokkumer zelven is
dit onderscheid zeer wel te hooren en te zien. De Friezen mogen de
Noord-Brabanders en Limburgers dooréén werpen, en niet
afzonderlijk onderkennen, Bosschenaren en Maastrichtenaren, die
van Breda en die van Roermond, zijn diep doordrongen van het
verschil dat er tusschen hen onderling bestaat. De Hollander, in ’t
algemeen de Nederlander uit het Westen en het Zuiden des lands
moge al Groningerlanders en Friezen over eenen en den zelfden
kam scheren en niet onderscheiden, de Amsterdamsche
grootstedeling moge die twee gelijkelijk als „buitenlui”, als
„provincialen, uit het Noorden” bestempelen en ze niet
onderscheidenlijk onderkennen, voor den Fries en den
Groningerlander zelven, over en weêr, zijn de bijzondere kenmerken,
die hen onderscheiden, zeer duidelijk en zeer groot, en de
Leeuwarder begrijpt zoo min als de Groninger hoe de Hollander den
een met den ander als in eenen adem kan noemen, hoe hij den een
met den anderen kan verwisselen en verwarren.

In oude tijden, toen de gelegenheden van onderling verkeer

tusschen de verschillende Nederlandsche gewesten, ook tusschen
de verschillende steden en dorpen van het zelfde gewest zoo veel
minder en geringer waren dan thans, kwamen de menschen, over ’t
algemeen genomen, uit de eene plaats vaak weinig of niet, soms
schier nooit in aanraking met die uit eene andere plaats, al ware ’t
ook dat die twee plaatsen, naar ons hedendaagsch begrip, volstrekt
niet verre van elkander af lagen. Natuurlijk bleven, ten gevolge van
dit besloten zijn binnen de muren en wallen en grachten van de
eigene stad, hoogstens binnen de [5]grenzen van de eigene gouw,
de oude volkseigenheden steeds vast en duidelijk in wezen, bleven
scherper begrensd, hielden veel langer stand dan heden ten dage,
nu schier de helft van de Nederlanders niet meer woont in de
plaatsen, waarin ze geboren en groot gebracht zijn, waar hunne
maagschap van oudsher gezeten is.

Het onderlinge verschil tusschen de ingezetenen van de eene plaats

en die van de andere, werd ook wel eene oorzaak van min
vriendelijke verhouding over en weêr, van onderlingen naijver—ja,
als ’t hoog liep, van onderlingen afkeer, zelfs van haat.
Kleingeestigheid, bekrompenheid, uit onkunde geboren, weêrhield,
aan den eenen kant, wederzijdsche erkenning als volks-, als
stamgenooten, en mat, aan de andere zijde, het onderlinge, veelal
onwezenlijke verschil ten breedsten, ten hatelijksten uit.
Leeuwarders en Dokkumers, bij voorbeeld, gevoelden zich niet als
volksgenooten, als Friezen, de eene zoo goed als de andere, maar
als Leeuwarders en Dokkumers op zich zelven, als „L e e u w a r d e r
G a l g e l a p p e r s ” en als „D o k k u m e r G a r n a t e n ”, zoo als
men elkanderen over en weêr betitelde, ja wel uitschold. Tusschen
Amsterdammers en Haarlemmers, al hoe nabij elkanderen hunne
steden ook gelegen zijn, heerschte in de 16e eeuw de grootste
naijver—een naijver die zich onder anderen lucht gaf in de
spotnamen „K o e k e t e r s ” en „M u g g e n ”, die men elkanderen
wederkeerig toevoegde—een naijver die, bij voorbeeld, ook blijkt uit
het min of meer smalende vers, waarmede de blijspeldichter
Gerbrand Adriaense Brederoô, een Oud-Amsterdammer in merg en
been, de Haarlemmers uitdaagde:

„Haerlemsche drooge harten nu,

Toont nu eens wie gy syt!
Wy Amsterdammers tarten u
Te drincken eens om stryt.”
En juist zulk eene verhouding bestond er tusschen den Zwolschen
B l a u w v i n g e r en den Kamper S t e u r , tusschen den
Deventerschman en den Zutfenaar, tusschen den Franeker
K l o k k e d i e f en den Harlinger To b b e d a n s e r , tusschen den
Rotterdammer en den Dordtenaar, tusschen den Emder
P o t s c h ij t e r en den Auriker P o g g e , tusschen den
Antwerpschen S i n j o o r en den Mechelschen
M a n e b l u s s c h e r , tusschen den Gentenaar [6]en den Bruggeling,
tusschen den K e u n e t e r van Duinkerke en den D r i n k e r van St.
Winoksbergen.

Overal in al de Nederlanden, Noord en Zuid, en in aangrenzende

stamverwante gewesten die thans tot Duitschland en Frankrijk
behooren (Oost-Friesland, Bentheim, Munsterland, Fransch-
Vlaanderen en Artesië), had men oudtijds zulke spotnamen voor de
inwoners van steden en dorpen; en al mogen die namen
tegenwoordig al minder sterk op den voorgrond treden als in vorige
tijden het geval geweest is, ze zijn toch heden ten dage nog
geenszins volkomen verdwenen. Oudtijds gaf de onderlinge naijver,
zich vooral ook uitende in het wederkeerig elkander noemen en
schelden met spotnamen, wel aanleiding tot zeer gespannen
verhoudingen, tot wrevel en haat, tot vechtpartijen zelfs, waarbij men
elkanderen wel bloedige koppen sloeg. Dit behoort in onzen tijd tot
het verledene, maar de oude spotnamen zijn nog wel bekend, en
worden nog wel eens gebruikt, zij het dan ook in tamelijk
onschuldige plagerij, of geheel in scherts.

Deze oude spotnamen zijn voor een goed deel belangrijk in menig
opzicht. Velen daarvan zijn reeds zeer oud en dagteekenen uit de
middeleeuwen. Velen ook berusten op het eene of andere
geschiedkundige feit, anderen op het wapen dat eigen is aan stad of
dorp (K l o k k e d i e v e n van Franeker, B a l k e d i e v e n van ’t
Ameland, M o l l e n van Schermerhorn). Anderen weêr danken hun
ontstaan aan het eene of andere bijzondere voorval, waarbij door
den nabuur, den tegenstander, in ’t geven van den spotnaam, juist
de domme, de belachelijke zijde der zaak werd in ’t licht gesteld
(K a l f s c h i e t e r s van Delft, K e i s l e p e r s van Amersfoort,
M a n e b l u s s c h e r s van Mechelen, R o g s t e k e r s van Weert).
Weêr anderen zijn ontleend aan eenen bijzonderen tak van handel,
van nering of bedrijf, die in de eene stad bestond, in de andere niet;
G o r t b u i k e n of G o r t z a k k e n van Alkmaar—te Alkmaar
bestonden oudtijds vele grutterijen, en de Alkmaarsche gort was wijd
vermaard in den lande; B o t e r v r e t e r s van Diksmude en
K a a s m a k e r s van Belle—beide deze Vlaamsche plaatsen zijn
van ouds bekend om hare zuivelbereiding. Sommigen ook zijn
ontstaan door de eene of andere lekkernij, die in de eene of andere
stad bijzonder gemaakt en [7]door de inwoners bij voorkeur gegeten
of gedronken werd. (K o e k e t e r s van Amsterdam,
K l i e n r o g g e n van de Joure, D ú m k e f r e t t e r s van Sneek,
M o l b o o n e n van Groningen, R o o d b i e r d r i n k e r s van
Harelbeke.)

Kieskeurig waren de oude Nederlanders geenszins, in het bedenken

en gebruiken van spotnamen. Van daar dat sommige dezer namen
heden ten dage slechts ternauwernood in beschaafd mannen-
gezelschap genoemd kunnen worden; (Z a n d p i s s e r s van de
Zijpe, G r u p p e n d r i e t e r s van Oldenzaal, P o t s c h ij t e r s van
Emden, L u z e k n i p p e r s van Eernewoude,
M o s t e r d s c h ij t e r s van Diest). Maar, jufferachtig preutsch moet
men niet zijn, als men sommige eigenaardigheden onzer voorouders
in nadere behandeling neemt.

Al deze Oud-Nederlandsche spotnamen te zamen genomen geven

een veelal verrassend, ook leerzaam en soms niet onvermakelijk