PHYSIOLOGY OF DEGLUTITION

DEGLUTITION

 Deglutition is the act of swallowing, through which a food or

liquid bolus is transported from the mouth through the
pharynx and esophagus into the stomach.

 Normal deglutition is a smooth coordinated process that

involves a complex series of voluntary and involuntary
neuromuscular contractions and typically is divided into
three distinct phases:
 Oral
 Pharyngeal
 Esophageal
ORAL
PHASE

1. ORAL PREPARATORY PHASE

2. ORAL PHASE PROPER

ORAL PREPARATORY PHASE
 This phase is where the food is readied for swallowing
by reducing & mixing it with saliva, by the muscles
of jaw and oral cavity.
 Jaw is closed by jaw elevator muscles ( temporalis,
masseter & medial pterygoid).
 Lips maintain a seal under the action of Orbicularis
oris.
 Food is returned from the vestibule by contraction of
buccinators.
 Through out this phase, the soft palate is lowered &
Ant and Post pillars approx. under the action of
palatoglossus & palato pharyngeus muscles.


Thus, the oral cavity is sealed post. & the
airway remains open.

 Bolus is progressively accumulated on the posterior

surface of the tongue, by several cycles of upward and
downward movement on the tongue surface.
 When the bolus consistency ( sensed by mechano-receptors in
the oral cavity) is suitable for swallowing, the oral phase
proper begins.
ORAL PHASE
PROPER
 The first event is mandibular elevation

 Although the mouth does not have to be

completely closed, it is hard to swallow with an
open mouth.

 Mandibular elevation assists the suprahyoid muscles

in raising the hyoid bone

 Next, the tip of the tongue is elevated towards the

hard palate by the action of genioglossus muscle
 Blade of the tongue then moves up due to contraction
of intrinsic muscles.

 These movements are accompanied by lifting the floor

of the mouth under the action of stylohyoid.

 Asthe bolus reaches the back of the tongue ,the soft

palate is elevated by tensor and levator veli palatini to
protect the nasopharynx.
PHARYNGEAL PHASE
 Asthe bolus enters the oropharynx, it makes
contact with faucial pillars or with the mucosa
overlying the posterior pharynx, the region
which is sensory innervated by glossopharyngeal
nerve.

 Hereafter swallowing becomes reflexive

 Pharyngeal phase consists of a sequence of

events that ensures that the airway is protected
during bolus transport.
 Diaphragmaticcontraction is inhibited making
simultaneous breathing and swallowing impossible.

 Softpalate is elevated to ensure closure of the

nasopharynx.

 Vocalcords start to close to protect the airway, either

do the vestibular folds.

 The larynx is closed by the contraction of muscles of

laryngeal inlet(AEF, interarytenoid and thyro
epiglottic) resembling a draw string purse.
 The larynx is closed under the contraction of
suprahyoid muscles, in order to narrow the laryngeal
inlet and moving it towards the pharyngeal surface of
epiglottis.
 As the bolus moves in to oropharynx, the epiglottis
moves downwards.

 This downward movement occurs in 2 distinct

stages.
1.movement from vertical to horizontal position
2.movement from horizontal to below horizontal
in order to cover the narrow laryngeal inlet.
 The first epiglottis movement is passive, due to the
forces generated by compression of the pre epiglottic
adipose fat and ligamentous attachment of
epiglottis.

 Thesecond movement occurs by a combination of

passive and active(contraction of thyroepiglottic and
hyoepiglottic) components.
 Thebolus enters the pharynx which is widened,
resembling the engulfing of prey by a snake.
Widening is partly due to relaxation of constrictor
muscles and partly due to anterior movement. Of the
pharynx under the action of suprahyoid muscles.

 As the food passes over the post. Part of the epiglottis,

it is diverted into the pyriform fossae. Solids tend to
go straight over the epiglottis, whereas liquids are
diverted laterally.
OESOPHAGEAL
PHASE
 The crico pharyngeus muscle relaxes so the
upper oesophageal sphincter opens, bolus
is passed on into & through the sphincter
& oesophagus by peristalsis.

 Tensor & Levator veli palatini relax, lowering

the soft palate, laryngeal inlet & vestibule open-
> hyoid & larynx drops -> at the very end stage
of swallowing, the glottis open.
NEURAL
CONTROL
 Neural control of swallowing involves a number of
different regions of the CNS, extending from the
motor nuclei within the brainstem, up to the cortex.
The act of swallowing is regulated by sensory
feedback.
 The initiation of swallowing can either be as a
voluntary act, or a reflex as the result of stimulation of
the mucosa in the oral cavity. The latter may occur
during saliva accumulation or by presence of food or
liquid.


Due to anatomical & physiological close
relationship between swallowing, ventilation &
mastication, there is extensive overlap in the
brainstem areas controlling these functions.
 Thevoluntary initiation of swallowing involves b/l
areas of frontal, pre-frontal & parietal cortices. Frontal
swallowing centre is associated with motor control of
swallowing. This centre includes-
 Lower pre-central & post inferior frontal gyri
- oral phase
 Middle frontal & anterior inferior frontal gyri
- pharyngeal & oesophageal
 Voluntarysensory control of swallowing is mediated
by the parietal cortex.

 Swallowing control is asymmetrical with projections

from one hemisphere being larger than the other,
independent of handedness.

 This explains why damage to the hemisphere that is

source of greater projection to the swallowing centres
in the brain stem will cause initial difficulty, and
recovery the occurs as the intact projection from the
undamaged hemisphere is re organized.
 Descending pathways project from the frontal
swallowing areas of cortex to the medullary
swallowing centers within the medulla
 There are a number of nucleus in the medulla
,involved in control of swallowing.
 Swallowing is initiated by the touch or pressure
sensation from the posterior part of the oral cavity or
oropharynx.
 The nuclei receiving afferent input include -

Nucleus tractus solitaries

Spinal trigeminal nucleus
 The efferent pathways from the medulla and pons to
the swallowing muscles include –

1. nucleus ambigus->for muscles of the palate,

pharynx and the larynx.
2. motor nuclei of hypoglossal->tongue
3.motor nuclei of trigeminal -> jaw
4.motor nuclei of facial->lips