Ch.

Physiology of Mastication
and Deglutition
 Introductory Terms

 Dysphagia: A disorder of swallowing

 Bolus: ball of food or liquid to be swallowed

 Mastication: the process of preparing food for

swallowing
• Moving food onto the grinding surfaces of the teeth
• Chewing
• mixing it with saliva in preparation for swallowing
 Deglutition: the process of swallowing
• Both the two above concepts require integration of lingual,
velar, pharyngeal, facial muscle movement, laryngeal
adjustments, respiratory control
 Introductory Terms
 Perioral region: around the mouth
 Rooting Reflex: reflexive response of infant to
tactile stimulation of the cheek or lips, infant
turns toward stimulus, opens mouth
 Sucking Reflex: tongue protrusion and retraction
in preparation for receipt of liquid; stimulated by
contact to the upper lip
 Esophageal Reflux: esophageal regurgitation into
the hypopharynx
 Nasal regurgitation: loss of food or liquid through
the nose
 Peristaltic: Wavelike
 Introductory Terms
 Oral Transit Time: time required to
move the bolus to the point of
initiation of the pharyngeal stage of
swallowing
 Pharyngeal Transit Time: time
required to move the bolus from the
beginning of pharyngeal swallow to
the time the bolus enters the
esophagus
 Organizational Patterns
 Oral Preparatory Stage
• Stage in which food is prepared for swallow
 Oral Stage
• Bolus transmitted to pharynx
 Pharyngeal Stage
• Bolus transmitted to the esophagus
• Numerous physiological responses
 Esophageal Stage
• Food is transported from the upper esophageal
region to the stomach
 Deficit Patterns
 Oral Preparatory Stage
• Neuromuscular deficits
 Loss of sensation and awareness
 Weak buccal musculature
 Weak muscles of mastication may cause inadequately
chewed food
 Weak lingual muscles may cause poor mixture of
saliva with food, inadequate bolus production, difficulty
compressing bolus onto hard palate
 Weak soft palate muscles may cause the velum to not
be fully depressed, tongue not adequately elevated in
back, permitting food to escape into the pharynx prior
to initiation of pharyngeal reflexes
 Food entering pharynx prior to a reflexive response
may reach the open airway and produce an aspiration
pneumonia
 Deficit Patterns
 Oral Stage
• Sensory and Motor dysfunction
 Weakened movements cause reduced
oral transit time, food may remain on
tongue and hard palate following transit
 Epiglottis fail to invert over laryngeal
opening, limited elevation of the hyoid,
may be increased pooling of food or
liquid in the valleculae
 Difficulty initiating a reflexive swallow
may be due to a sensory deficit
 Deficit Patterns
 Pharyngeal Stage
• Sensory and Motor Dysfunction
 Slow velar elevation may result in nasal regurgitation
 Reduced sensation of fauces, posterior tongue,
pharyngeal wall, soft palate may cause elevated
threshold for trigger of swallowing reflex
 Reduced function of pharyngeal constrictors may
result in slowed pharyngeal transit time of bolus and
individual may reinitiate respiration
 Weakened pharyngeal function may result in residue
left in the valleculae
 Failure of the hyoid and thyroid to elevate may result
in loss of airway protection, food may fall into larynx
and be aspirated on breathing
 Deficit Patterns
 Esophageal Stage
• GERD: acids from the stomach flow to
the esophagus and pharynx, may be
UES or LES problem or both
• Hiatal Hernia: LES may malfunction
allowing reflux into esophagus
• Congenital Malformation: stenosis, see
figure 9-4
 Neurophysiology

 Gustation
• Taste mediated by 3 cranial nerves
 V!! mediates sense of taste from anterior 2/3 of the tongue,
sweet and sour sensations, and of palate. Sides transmit
salt and sour.


 IX mediates sense of taste, primarily of bitterness from

posterior 1/3 of tongue. Sides transmit salt and sour
 X mediates sense of taste from epiglottis and esophagus
 Umami: taste receptor which processes monosodium
glutamate.
 Neurophysiology

 Gustation
 Tastes, bitter and sour may typify poison and elicit
a protective response
• Gagging
• Coughing
• Apnea
• Salivation (encapsulates the material and protects the
oral cavity
 Neurophysiology

 Gustation
 Taste can elicit motor responses that may or may
not be under volitional control
• Gag response
 Elevation of the larynx

 Clamping of the vocal folds

 Elevation of the velum

 Protrusion of the tongue

 Neurophysiology

 Gustation
 Taste can elicit motor responses that may or may
not be under volitional control
• Coughing
 Tightly closing VF and supraglottic structures

 Compressing of abdomen and thorax

 Forcefully blowing VF apart

 Neurophysiology

 Olfaction
• Olfactory chemoreceptors in nasal mucus
membrane
• Sense of smell transmitted to olfactory bulb
in cranial space
 Neurophysiology

 Tactile Sense
• In face and oral cavity, primarily mediated by
V, but IX and X are associated
 Neurophysiology

 Thermal Receptors
• In face and oral cavity, primarily mediated by
V, but IX and X are associated
• Same as pain sensors, bare nerve endings
• Differentiate warm, hot, cool, cold: receptors
are tuned to particular temperatures
 Neurophysiology

 Muscle stretch and Tension sense

• In face and oral cavity, primarily mediated by
V, but IX and X are associated