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a series of coordinated muscular contraction that moves a bolus of food from oral cavity through the esophagus to the stomach
Okeson, 2008
1.Degrees of fineness of the food
2.Intensity of the taste extracted
3.Degree of lubrication of the bolus
Practice : To appreciate the mechanism of masseter muscleStep : 1. Patient’s position: sit up straight 2. Clinicians: prependicular 3. Ask the patient to swallowing the saliva 4. Please stay attention to the symmetry ofResult: Muscle function (+) Symmetry Muscle function (-) Asymmetry
Medilexocon.com
• Somatic Swallow:swallowing pattern with muscular contractions and uses the teeth for mandibular stability that appear to be under control of the person
• Visceral Swallow:immature swallowing pattern of an infant or older person with tongue thrust, resembling peristaltic, and wavelike
• Ask your patients to swallow her/his saliva, if there’s no tongue trust SOMATIC SWALLOW
• Ask your patients to swallow her/his saliva, if there’s tongue trust VISCERAL SWALLOW
Swallowing patterns evolve as a changes adapted in the form of food, an increase in activity of muscle mastication, and the first molar tooth eruption.
Pinkham, 1999
The transition generally occurs in children aged 3-10 years.
Normal adult swallowing pattern obtained at age 4 ½ to 5 years, so that the pattern of infantile swallowing may transition to adult swallowing pattern completely at 8 years old.
Pinkham, 1999
LACK OF TOOTH SUPPORT AS A RESULT POOR TOOTH POSITION OR ARCH RELATIONSHIP MAY RESULT NO TRANSITION FROM INFANTILE SWALLOW TO ADULT SWALLOW.
Okeson, 2008
OVERRETENTION OF THE INFANTILE SWALLOW CAN RESULT IN LABIAL DISPLACEMENT OF THE ANTERIOR TEETH BY THE POWERFUL TONGUE MUSCLE.
THIS MAY PRESENT CLINICALLY AS AN ANTERIOR OPEN BITE. Okeson, 2008
Average tooth contact during swallowing is 683 msec. This is more then 3 times longer than mastication.
Okeson, 2008
The force applied the teeth during swallowing is 66.5 pounds, is 7.8 pounds more than mastication.
Okeson, 2008
When the mandible is braced, it is brought into a some what posterior or retruded position. If the teeth do not fit together well in this position, an anterior slide occurs to the intercuspal position.
Okeson, 2008
Bottom LineAs a clinician, we should know that the normal time of swallowing is less than 1 seconds.
The Importance
• the sensory input from the trigeminal nerve synapse in the spinal V nucleus
• it’s also important to appreciate that the most caudal region of the spinal tract nucleus extends inferiorly into the region where the upper cervical nerves enter the spinal cord (CN I – V)Okeson,
2008
The Factors
• Quality of the intercuspal position will determine position mandible during swallowing, not retruded relationship with fossa.• Muscle engrams and reflex activity maintain closure of the mandible into the intercuspal position
Okeson, 2008
PRACTICE
1. Patient sit up straight and relax
2. Ask the patient to swallow3. Notice the cheek while
swallowing
To Evaluate Mastication Muscle
RESULT
- Masseter muscle pressing towards the midline and the cheek muscle should not move at all
- If left or right cheek bulging
PRACTICE
What is it?
Oral phase of swallowing where the tongue cups to position the food, fluid or saliva for swallowing
www.beckmannoralmotor.com
The Process
• Selective parting of bolus by tongue• Bolus placed on dorsum of the tongue• Tongue pressed lightly against the hard palate• Lips are sealed, teeth brought together• Reflex contraction in the tongue, pressed bolus backward, transferred to pharynx
Okeson, 2008
PRACTICE
1. Patient sit up straight and relax
2. Ask the patient to swallow3. Notice the lips while
swallowing
To evaluate first stage of swallowing
Getting To Know
Second Stage of Deglutition : occurs when bolus reaches the area of palatoglossal folds. It is also known as the pharyngeal phase of swallowing.
www.ouhsc.edu
Second Stage of Deglutitionis under involuntary neuromuscular control which is stimulated by posterior tongue movement and stimulation of pharyngeal mucosa that stimulated the swallowing reflex.
www.ouhsc.edu
Getting To Know
www.ouhsc.edu
The sequential steps to pharyngeal phase of swallowing are:1.Velum elevating to contact posterior pharyngeal wall and block upward movement of bolus into nasopharynx 2.Elevation of the larynx and hyoid bone toward base of tongue, bringing a passive flipping over of the epiglottis to cover the glottis 3.Contraction of pharyngeal constrictor muscles from superior to inferior direction4.Relaxation of the upper esophageal sphincter to allow passage of bolus into esophagus
The Mechanism
Practice: to appreciate any abnormalities of
second stage deglutition1. Sit up straight and relax2. Ask the patient to swallow his/
her saliva
Result:• Patient can swallow the saliva easily
and the swallowing lasts less than 2 second → NORMAL
• Patient has difficulty in swallowing and it lasts longer than 2 second → SWALLOWING DISORDER
The third stage of swallowing consist of passing the bolus through the length of the esophagus and into the stomach.
Okeson, 2008
?
Peristaltic waves carry the bolus down the esophagus. The waves take 6 to 7 seconds to carry the bolus through the length of the esophagus.
Okeson, 2008
The process
Practice: to appreciate the clinical examination of
esophagus phase Lets swallowing
Result :Normal → feel no obstacle in esophagusProblem feel an obstacle in esophagus
Clinical Examination
Swallowing occurs 590 times during 24-hour•146 cycles during eating•394 cycles between meals while awake•50 cycles during sleep
Okeson, 2008
Frequency of swallowing
Speech is the third major function of the masticatory system and occurs when a volume of air is forced from the lungs by the diaphragm through the larynx and oral cavity.
Okeson, 2008
What is it ?
Controlled contraction and relaxation of the vocal cords create a sound with the desired pitch
Okeson, 2008
The Importance
The HumanHuman have ability to form
intricate sound using vowels and consonantsThe Animal
Animal don’t have ability to produce as many as distinguishable sounds because of simpler anatomy
The Difference
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By varying the relationship of the lips and the tongue to the palate and teeth, one can produce a variety of sounds. Okeson,
2008
• The tongue touches the maxillary th sound.
• The lower lip touches the incisal edges of the maxillary teeth f and v sounds.
• The posterior portion of the tongue rises to touch the soft palate k or g
The MechanismThe Mechanism
calleteach.wordpress.com
Important point:As a clinician we should aware about combination of the anatomic structures that use to form many of these sounds.