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Dysphagia lecture summary

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This is a summary of the English course Dysphagia in the first semester of phase 3 at Thomas More Antwerp. This is taught by Leen Van den Steen. The summary includes extra notes to the ppt slides and sometimes Dutch clarification.

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  • December 27, 2023
  • 49
  • 2023/2024
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Dysphagia

1 Lecture 1: Swallowing: anatomy & physiology
Swallowing

Mensen eten en drinken niet enkel voor voldoening of hydratatie, maar ook voor het ‘plezier’ vb:
cafe, restaurant. Dit is dus een belangrijke activiteit in mensen hun leven.

1.1 Anatomy
o Oral cavity
 Mensen met problemen in oral cavity hebben
problemen met slikken




o Tong
 Belangrijk orgaan!
 Zonder tong kan je niet spreken, slikken
 Waarom zo belangrijk? -> het is een ‘muscular hydrostat’. Dit is geen spier zoals de
biceps of triceps. Grote verschil is dat alle spieren vastgemaakt zijn tussen 2 benige
structuren, de tong is dat niet, dit heeft maar 1 benige structuur nl. het hyoid. Het kan
moeilijk vergeleken worden met andere spieren.
2e verschil: het volume van de tong wil altijd hetzelfde zijn, bij een andere spier wordt
het volume dikker of dunner. Dit is belangrijk in het herstel van dysphagia.
 ‘Floor of mouth = genioglossus, geniohyoid en
mylohyoideus. Ook belangrijke spieren tijdens
slikken.
o Pharynx
 Nasopharynx
- Schedel tot zachte verhemelte
- Zachte verhemelte is belangrijk deel!




 Oropharynx
- Ligt achter ‘oral cavity’. Van uvula tot hyoid (basis van de tong).
- Base of Tongue (BOT)
- Valleculae (blijft makkelijk eten achter zitten als je niet krachtig genoeg slikt)

,  Hypopharynx
- Laagste deel van de farynx
- Is verbonden aan de oesophagus (gesloten)
- Inferieur tov de epiglottis
- Kruising tussen luchtweg en de slokdarm.

Belangrijke regio’s
- Epiglottis
- Piriform sinus
- Esophageus
- trachea




1.2 Definition Swallowing
Swallowing = Normal swallowing consists of a set of physiologic behaviors which result in food, liquid
or other substances moving safely and efficiently from the mouth to the stomach.




2

, ‼ Safely: indien het slikken niet veilig gebeurt loopt er voedsel naar de longen en ga je hoesten.
‼ Efficiently: Het slikken kan lang duren en veel tijd in beslag nemen. Indien het eten langer
duurt dan normaal gebeurt het slikken niet efficiënt.


1.3 Physiology
3 phases

1.3.1 Oral phase
1.3.1.1 Preparatory phase
o Bolus preparation
o Chewing
o Tongue, lips, labial and buccal musculature, movement of the jaw
1.3.1.2 Transport phase
o Tongue moves bolus posteriorly in oral cavity
 Tongue – palatum pressure
 Bolus driving force (golfbeweging)
 Bolus propulsion (force nodig !!)




1.3.2 Pharyngeal phase
o 4 different valves (doorwegen die moeten sluiten zodat eten
er niet door komt)
 food into oesophagus
 NOT in airway / nose)

o 2-3 seconds

1.3.2.1 Velopharyngeal valve
o Soft palate & pharyngeal walls
o Prevent food entering the nose
o Pressure pharynx




1.3.2.2 Laryngeal valve – 3 levels
o Glottal closure (1)  apneu (je kan niet ademen terwijl je slikt)
o Arytenoid adduction (2)

, o Epiglottal folding (3)




1.3.2.3 Base of the tongue (BOT)
o Contact with posterior pharyngeal walls
o Drives bolus through the pharynx
o Pharyngeal contraction




1.3.2.4 Upper oesophageal sphincter (UES)
o At rest: in some level of contraction
o Sphincter is closed during respiration
o Opening of the UES @ 3 levels:




1.3.2.5 Muscle strength
o Key element
o Stripping wave: pharyngeal constrictors
o One by one the muscles contract and push the bolus down




4

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