DTSD 304 : Anatomy of Head and Neck

Wanida Sripairojthikoon
Department of Anatomy, Faculty of Dentistry
Mahidol University
 Outline of contents
• Deglutition = Swallowing
• Digestive system and its
organs
• Definition of deglutition
• Stages of deglutiton
• Deglutition reflex
• Deglutition disorder
 Digestive system
• Digestive system
– function to prepare food
for cellular utilization
– involve following
activities :
• ingestion
• mastication
• deglutition
• peristalsis
• digestion
• absorption
• defecation
• Deglutition is one activity of
digestive system
 Organs of digestive system
• Tubular gastrointestinal
tract (GI tract)
– From mouth to anus, 6-9
meters long
– Oral cavity, pharynx,
esophagus, stomach,
small intestine, large
intestine and anus
• Accessory digestive
organs
– Salivary glands,
pancreas, liver and gall
bladder
 Deglutition = Swallowing

Deglutition is the complex process

that moves bolus of food from
mouth through pharynx into
esophagus and then to stomach
 Organs of deglutition and related structures

• During deglutition, the muscles of

mouth, pharynx, larynx and
esophagus coordinate properly in a
complex process; to move food and
liquid into stomach
– Organs of deglutition
• Oral cavity
• Pharynx
– (Nasopharynx)
– Oropharynx
– Laryngopharynx
• Esophagus
• Stomach
• The airway is protected by correct
movement of larynx, so that food and
liquid not enter the airway
– Related organ of deglutition
• Larynx
Digestive system & Respiratory system

Oropharynx

Pharynx is the common pathway for air, food and drink

 Oral cavity

Oral cavity, upper opening of digestive system, contains tongue and teeth
 Palate

Palate, roof of mouth, separates nasal and oral cavities

 Tongue

Tongue, aids in mastication, deglutition and speech

 Pharynx

Pharynx, most of the time subserves respiration instead of deglutition

 Larynx

Larynx, organ of voice, entrance to lower respiratory passage

 Stages of deglutition
• Deglutiton is a
continuous process
from oral cavity to
stomach, divide into 3
stages
1. oral phase
2. pharyngeal phase
3. esophageal phase
 First stage of deglutition
• The first stage is voluntary
and initiate deglutition
process
– A mass of chewed,
moistened food, a bolus, is
moved to the back of the
oral cavity by the tongue
– The lip and buccal muscles
help keep bolus from
dispersing either anteriorly
out of oral cavity or laterally
into oral vestibule
 Oral phase

• Intact labial seal

• Anterior to posterior tongue movement
 Second stage of deglutition
• The second stage is
involuntary and rapid
– The entire process
occurs in less than 2
seconds
– Start from the point at
where the deglutition
reflex is triggered at the
anterior faucial arch
through the upper
esophageal sphincter
into the esophagus
– The bolus is propelled by Anterior faucial arch
pumping action of tongue • Soft palate
base and constriction of • Palatoglossal arch
pharyngeal muscles
• Base of tongue
Pharyngeal phase

• Soft palate is elevated, sealing off the

nasopharynx from oropharynx, prevent reflux of
food into nasal cavity
• Initiation of pharyngeal peristalsis to pick up and
carry the bolus
• Elevation and closure of larynx, to prevent food
from entering airway
• Upper esophageal sphincter (cricopharyngeus
muscle) relaxation
 Pharyngeal phase

Larynx is closed off to the bolus by several mechanisms:

– Larynx is pulled upward and anteriorly by muscles of neck, cause
epiglottis to swing backward over the opening of larynx.
– Closure of larynx at all 3 sphincters
• Epiglottis / aryepiglottic folds
• False vocal folds
• True vocal folds
– Cessation of respiration
 Third stage of deglutition
• The third stage is also
involuntary
– 8-20 seconds transmit time
– Start from the point where
the bolus enters the
esophagus at the upper
esophageal sphincter
– Until the bolus passes into
stomach at the lower
esophageal sphincter
• During third stage,
combination of gravity and
peristalsis, push the bolus
from esophagus down to
stomach
Deglutition
• Oral phase : (a)
• Pharyngeal phase : (b)
• Esophageal phase :
(c), (d), (e)
 Deglutition reflex
• Deglutition reflex is mainly a protective reflex
• Two main things take place during reflex
– A squeezing action squeezes the bolus with muscles
that pull food down to the stomach. This action is called
peristalsis.
– Larynx closes off to keep food out of the airway. The
epiglottis folds down and the vocal folds shut.
Deglutition reflex

• Sensory impulses
transmitted as a result of
stimulation of deglutition
receptors on the fauces
– Tonsils
– Soft palate
– Base of tongue
– Posterior pharyngeal wall
• By the 7th, 9th and 10th
cranial nerves
Deglutition reflex
• Sensory impulses reach
the deglutition center in
brain stem
• Motor function is
mediated through the
5th, 9th, 10th and 12th
cranial nerves
• To initiate muscle
contraction
– Elevation of soft palate
– Elevation and closure of
larynx
– Peristalsis of pharynx and
esophagus.
 Deglutition disorder
• Difficulty of deglutition is known as dysphagia
• Deglutition can be restricted if the muscle of the mouth,
pharynx, larynx or esophagus are weak or uncoordinated.
– Tongue dysfunction – prevent normal bolus movement through the
oral cavity
– Palatal dysfunction – nasal regurgitation during deglutition
– Dysfunction of pharyngeal constrictors
• poor bolus propulsion through pharynx
• Pooled bolus can then easily spill over into larynx
– Dysfuction of larynx – can cause aspiration. If larynx does not
close off and tilt out of the way at the right moment, food or drink
may get into airway.
– Dysfunction of upper esophageal sphincter - lead to difficult
passing from pharynx into esophagus
• Deglutition problem can lead to coughing, airway obstruction,
pneumonia and even death
 Essential requirements of deglutition
1. Preparation of suitable size and consistency of
bolus
2. Prevention of bolus disperse during various phases
of deglutition
3. Create pressure to propel bolus in forward direction
4. Prevention of bolus to enter nasopharynx and
larynx
5. Rapid passage through pharynx to esophagus
during stop breathing
6. Prevent reflux from stomach into esophagus
7. Final clearance of residue from the tract
 Eat and drink safety

• Deglutition is generally safest when the

person is sitting straight, with head upright or
slightly forward
• Must be awake and alert, without distractions
such as television
• Allow more time to eat and drink
• Always make sure that one mouthful has
gone before offering the next