2 physiology-of-deglutition
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Transcript of 2 physiology-of-deglutition
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Physiology of Deglutition
Dr. Vishal Sharma
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Stages
1. Oral stage (lasts for 1 second, voluntary)
Preparatory phase
Propulsive phase
2. Pharyngeal Stage (1 second, involuntary)
3. Oesophageal Stage (8-20 seconds)
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Oral preparatory stage• Not required for liquids
• Solid food chewed, lubricated with saliva &
converted to a bolus
• Requires coordinated movement of lips, cheeks,
jaws & tongue against a closed oropharyngeal
isthmus
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Oral preparatory stage
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Oral propulsive stage
• Food bolus propelled backwards by pressing
of tongue against hard palate
• Approximation of tongue against hard palate
starts with tip of tongue & moves back
• Stage ends when food bolus crosses anterior
tonsillar pillar
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Oral propulsive stage
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Pharyngeal stage
1. Nasopharyngeal isthmus closed: soft palate
touches
Passavant’s ridge
2. Oropharyngeal isthmus closed: tongue base
touches
palate
3. Elevation of larynx: negative pressure in
hypopharyngeal lumen (suction
pump)
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Pharyngeal stage
4. Closure of larynx: below upwards
True vocal cords approximate
False cords approximate
Ary-epiglottic folds approximate
Temporary cessation of respiration
Epiglottis falls back over larynx inlet (?)
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Nasopharyngeal isthmus closed
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Elevation & closure of Larynx
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Oropharyngeal isthmus closed
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Pharyngeal stage
5. Posterior retraction of base tongue:
tongue driving
force
6. Pharyngeal constrictors contract
7. Elevation of pharynx
8. Opening of cricopharyngeal sphincter
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Tongue driving force
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Contraction & elevation of pharynx
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Opening of cricopharynx
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Oesophageal stage1. Closing of cricopharyngeal sphincter
2. Opening & descent of larynx
3. Primary peristalsis: large amplitude, propulsive
4. Secondary peristalsis: small amplitude,
propulsive, for food remnants
5. Relaxation of lower esophageal sphincter:
food bolus enters
stomach
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Closing of cricopharynx
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Opening & descent of larynx
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Oesophageal Peristalsis
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Peristalsis
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Intraluminal pressure changes
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Bolus enters stomach
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Neural Mechanism• Afferent: 5th, 9th & 10th cranial nerves
• Deglutition centre: medulla oblongata
• Efferent: 10th, 11th & 12th cranial nerves
tongue, pharynx, larynx & oesophagus muscles
• Cessation of respiration: connection between
deglutition & respiration centres in medulla
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Recap
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Oral preparatory stage
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Oral propulsive stage
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Nasopharyngeal isthmus closed
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Elevation & closure of Larynx
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Oropharyngeal isthmus closed
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Tongue driving force
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Contraction & elevation of pharynx
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Opening of cricopharynx
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Closing of cricopharynx
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Opening & descent of larynx
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Primary Peristalsis
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Bolus enters stomach
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Video-fluoroscopyLateral view
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Oral propulsive stage
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Larynx elevation
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Closure of nasopharyngeal isthmus & larynx
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Contraction of upper constrictor
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Contraction of middle constrictor
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Contraction of lower constrictor & relaxation of cricopharyngeal sphincter
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Cricopharyngeal sphincter closes & larynx opens
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Video-fluoroscopyAnterior view
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Contrast enters oropharynx
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Pyriform fossae fill symmetrically
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Contrast reaches crico-pharyngeal sphincter
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Cricopharynx opens & contrast enters esophagus
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Constrictors squeeze all contrast into esophagus
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No stasis
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Factors preventing reflux
Anatomical:
1. Lower oesophageal sphincter contraction
2. Pinch cock action of right crus of diaphragm
3. Oblique esophageal entry into stomach
4. Lower esophageal mucosal folds (valvular)
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Factors preventing reflux
5. Oblique gastric muscle around lower esophagus
6. Abdominal pressure > gastric pressure & intra-
thoracic pressure
Physiological:
1. Unidirectional esophageal peristalsis
2. Gastric emptying
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Thank You