Swallowing

Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a
substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing is an important
part of eating and drinking. If the process fails and the material (such as food, drink, or medicine) goes through the trachea, then
choking or pulmonary aspiration can occur[1]. In the human body the automatic temporary closing of the epiglottis is controlled by
the swallowing reflex.

The portion of food, drink, or other material that will move through theneck in one swallow is called abolus.

Contents
In humans
Coordination and control
Phases
Oral phase
Pharyngeal phase
Esophageal phase
Clinical significance

In non-mammal animals
See also
References
External links

In humans

Coordination and control

Eating and swallowing are complex neuromuscular activities consisting essentially of three phases, an oral, pharyngeal and
esophageal phase. Each phase is controlled by a different neurological mechanism. The oral phase, which is entirely voluntary, is
mainly controlled by themedial temporal lobes and limbic system of the cerebral cortex with contributions from the motor cortex and
other cortical areas. The pharyngeal swallow is started by the oral phase and subsequently is co-ordinated by the swallowing center
on the medulla oblongata and pons. The reflex is initiated by touch receptors in the pharynx as a bolus of food is pushed to the back
of the mouth by the tongue, or by stimulation of the palate (palatal reflex).

Swallowing is a complex mechanism using both skeletal muscle (tongue) and smooth muscles of the pharynx and esophagus. The
[2] .
autonomic nervous system(ANS) coordinates this process in the pharyngeal and esophageal phases

Phases

Oral phase
Prior to the following stages of the oral phase, the mandible depresses and the lips
abduct to allow food or liquid to enter the oral cavity. Upon entering the oral cavity,
the mandible elevates and the lips adduct to assist in oral containment of the food
and liquid. The following stages describe the normal and necessary actions to form
the bolus, which is defined as the state of the food in which it is ready to be
swallowed.

1) Moistening

Food is moistened by saliva from thesalivary glands (parasympathetic).

2) Mastication
Play media
Food is mechanically broken down by the action of the teeth controlled by the
Real-time MRI – swallowing
muscles of mastication (V3) acting on the temporomandibular joint. This results in a
bolus which is moved from one side of the oral cavity to the other by the tongue.
Buccinator (VII) helps to contain the food against the occlusal surfaces of the teeth.
The bolus is ready for swallowing when it is held together by (largely mucus) saliva
(VII—chorda tympani and IX—lesser petrosal), sensed by the lingual nerve of the
tongue (V3). Any food that is too dry to form a bolus will not be swallowed.

3) Trough formation

A trough is then formed at the back of the tongue by the intrinsic muscles (XII). The
trough obliterates against the hard palate from front to back, forcing the bolus to the
back of the tongue. The intrinsic muscles of the tongue (XII) contract to make a
trough (a longitudinal concave fold) at the back of the tongue. The tongue is then
elevated to the roof of the mouth (by the mylohyoid (mylohyoid nerve—V3),
genioglossus, styloglossus and hyoglossus (the rest XII)) such that the tongue slopes
downwards posteriorly. The contraction of the genioglossus and styloglossus (both
XII) also contributes to the formation of the central trough.

4) Movement of the bolus posteriorly

Sagittal view of mouth and pharynx
At the end of the oral preparatory phase, the food bolus has been formed and is
ready to be propelled posteriorly into the pharynx. In order for anterior to posterior
transit of the bolus to occur, orbicularis oris contracts and adducts the lips to form a tight seal of the oral cavity. Next, the superior
longitudinal muscle elevates the apex of the tongue to make contact with the hard palate and the bolus is propelled to the posterior
portion of the oral cavity. Once the bolus reaches the palatoglossal arch of the oropharynx, the pharyngeal phase, which is reflex and
involuntary, then begins. Receptors initiating this reflex are proprioceptive (afferent limb of reflex is IX and efferent limb is the
pharyngeal plexus- IX and X). They are scattered over the base of the tongue, the palatoglossal and palatopharyngeal arches, the
tonsillar fossa, uvula and posterior pharyngeal wall. Stimuli from the receptors of this phase then provoke the pharyngeal phase. In
fact, it has been shown that the swallowing reflex can be initiated entirely by peripheral stimulation of the internal branch of the
superior laryngeal nerve. This phase is voluntary and involves important cranial nerves: V (trigeminal), VII (facial) and XII
(hypoglossal).

Pharyngeal phase
For the pharyngeal phase to work properly all other egress from the pharynx must be occluded—this includes the nasopharynx and
the larynx. When the pharyngeal phase begins, other activities such as chewing, breathing, coughing and vomiting are concomitantly
inhibited.

5) Closure of the nasopharynx

The soft palate is tensed by tensor palatini (Vc), and then elevated by levator palatini (pharyngeal plexus—IX, X) to close the
nasopharynx. There is also the simultaneous approximation of the walls of the pharynx to the posterior free border of the soft palate,
which is carried out by the palatopharyngeus (pharyngeal plexus—IX, X) and the upper part of the superior constrictor (pharyngeal
plexus—IX, X).

6) The pharynx prepares to receive the bolus

The pharynx is pulled upwards and forwards by the suprahyoid and longitudinal pharyngeal muscles – stylopharyngeus (IX),
salpingopharyngeus (pharyngeal plexus—IX, X) and palatopharyngeus (pharyngeal plexus—IX, X) to receive the bolus. The
palatopharyngeal folds on each side of the pharynx are brought close together through the superior constrictor muscles, so that only a
small bolus can pass.

7) Opening of the auditory tube

The actions of the levator palatini (pharyngeal plexus—IX, X), tensor palatini (Vc) and salpingopharyngeus (pharyngeal plexus—IX,
X) in the closure of the nasopharynx and elevation of the pharynx opens the auditory tube, which equalises the pressure between the
nasopharynx and the middle ear. This does not contribute to swallowing, but happens as a consequence of it.

8) Closure of the oropharynx

The oropharynx is kept closed by palatoglossus (pharyngeal plexus—IX, X), the intrinsic muscles of tongue (XII) and styloglossus
(XII).

9) Laryngeal closure

It is true vocal fold closure that is the primary laryngopharyngeal protective mechanism to prevent aspiration during swallowing. The
adduction of the vocal cords is effected by the contraction of the lateral cricoarytenoids and the oblique and transverse arytenoids (all
recurrent laryngeal nerve of vagus). Since the true vocal folds adduct during the swallow, a finite period of apnea (swallowing apnea)
must necessarily take place with each swallow. When relating swallowing to respiration, it has been demonstrated that swallowing
occurs most often during expiration, even at full expiration a fine air jet is expired probably to clear the upper larynx from food
remnants or liquid. The clinical significance of this finding is that patients with a baseline of compromised lung function will, over a
period of time, develop respiratory distress as a meal progresses. Subsequently, false vocal fold adduction, adduction of the
aryepiglottic folds and retroversion of the epiglottis take place. The aryepiglotticus (recurrent laryngeal nerve of vagus) contracts,
causing the arytenoids to appose each other (closes the laryngeal aditus by bringing the aryepiglottic folds together), and draws the
epiglottis down to bring its lower half into contact with arytenoids, thus closing the aditus. Retroversion of the epiglottis, while not
the primary mechanism of protecting the airway from laryngeal penetration and aspiration, acts to anatomically direct the food bolus
laterally towards the piriform fossa. Additionally, the larynx is pulled up with the pharynx under the tongue by stylopharyngeus (IX),
salpingopharyngeus (pharyngeal plexus—IX, X), palatopharyngeus (pharyngeal plexus—IX, X) and inferior constrictor (pharyngeal
plexus—IX, X).This phase is passively controlled reflexively and involves cranial nerves V, X (vagus), XI (accessory) and XII
(hypoglossal). The respiratory center of the medulla is directly inhibited by the swallowing center for the very brief time that it takes
to swallow. This means that it is briefly impossible to breathe during this phase of swallowing and the moment where breathing is
prevented is known asdeglutition apnea.

10) Hyoid elevation

The hyoid is elevated by digastric (V & VII) and stylohyoid (VII), lifting the pharynx and larynx up even further
.

11) Bolus transits pharynx

The bolus moves down towards the esophagus by pharyngeal peristalsis which takes place by sequential contraction of the superior,
middle and inferior pharyngeal constrictor muscles (pharyngeal plexus—IX, X). The lower part of the inferior constrictor
(cricopharyngeus) is normally closed and only opens for the advancing bolus. Gravity plays only a small part in the upright position
—in fact, it is possible to swallow solid food even when standing on one’s head. The velocity through the pharynx depends on a
number of factors such as viscosity and volume of the bolus. In one study, bolus velocity in healthy adults was measured to be
approximately 30–40 cm/s.[3]

Esophageal phase
12) Esophageal peristalsis

Like the pharyngeal phase of swallowing, the esophageal phase of swallowing is under involuntary neuromuscular control. However,
propagation of the food bolus is significantly slower than in the pharynx. The bolus enters the esophagus and is propelled downwards
first by striated muscle (recurrent laryngeal, X) then by the smooth muscle (X) at a rate of 3–5 cm/s. The upper esophageal sphincter
relaxes to let food pass, after which various striated constrictor muscles of the pharynx as well as peristalsis and relaxation of the
lower esophageal sphinctersequentially push the bolus of food through the esophagus into the stomach.

13) Relaxation phase

Finally the larynx and pharynx move down with the hyoid mostly by elastic recoil. Then the larynx and pharynx move down from the
hyoid to their relaxed positions by elastic recoil. Swallowing therefore depends on coordinated interplay between many various
muscles, and although the initial part of swallowing is under voluntary control, once the deglutition process is started, it is quite hard
to stop it.

Clinical significance
Swallowing becomes a great concern for the elderly since strokes and Alzheimer's disease can interfere with the autonomic nervous
system. Speech Pathologists commonly diagnose and treat this condition since the speech process uses the same neuromuscular
structures as swallowing. Diagnostic procedures commonly performed by a Speech Pathologist to evaluate dysphagia include
Fiberoptic Endoscopic Evaluation of Swallowing and Modified Barium Swallow Study. Occupational Therapists may also offer
swallowing rehabilitation services as well as prescribing modified feeding techniques and utensils. Consultation with a dietician is
essential, in order to ensure that the individual with dysphagia is able to consume sufficient calories and nutrients to maintain health.
In terminally ill patients, a failure of the reflex to swallow leads to a build-up of mucus or saliva in the throat and airways, producing
a noise known as a death rattle (not to be confused with agonal respiration, which is an abnormal pattern of breathing due to cerebral
ischemia or hypoxia).

Abnormalities of the pharynx and/or oral cavity may lead to oropharyngeal dysphagia. Abnormalities of the esophagus may lead to
esophageal dysphagia. The failure of the lower esophagus sphincter to respond properly to swallowing is called
achalasia.

In non-mammal animals
In many birds, the esophagus is largely a mere gravity chute, and in such events as a
seagull swallowing a fish or a stork swallowing a frog, swallowing consists largely
of the bird lifting its head with its beak pointing up and guiding the prey with tongue
and jaws so that the prey slides inside and down.

In fish, the tongue is largely bony and much less mobile and getting the food to the
back of the pharynx is helped by pumping water in its mouth and out of itsgills.

In snakes, the work of swallowing is done by raking with the lower jaw until the
prey is far enough back to be helped down by body undulations.

See also Pelican swallowing a fish

Dysphagia
Occlusion
 Speech and language pathology

References
1. Dudik, J. M.; Coyle, J. L.; Sejdić, E. (August 2015)."Dysphagia Screening: Contributions of Cervical Auscultation
Signals and Modern Signal-Processing T echniques" (http://ieeexplore.ieee.org/abstract/document/7064736/)
. IEEE
Transactions on Human-Machine Systems. 45 (4): 465–477. doi:10.1109/THMS.2015.2408615(https://doi.org/10.11
09%2FTHMS.2015.2408615). ISSN 2168-2291 (https://www.worldcat.org/issn/2168-2291).
2. Jestrović, Iva; Coyle, James L.;Sejdić, Ervin (2015). "Decoding human swallowing via electroencephalography: a
state-of-the-art review"(http://stacks.iop.org/1741-2552/12/i=5/a=051001)
. Journal of Neural Engineering. 12 (5):
051001. doi:10.1088/1741-2560/12/5/051001(https://doi.org/10.1088%2F1741-2560%2F12%2F5%2F051001) .
ISSN 1741-2552 (https://www.worldcat.org/issn/1741-2552).
3. Clave, P.; De Kraa, M.; Arreola, V.; Girvent, M.; Farre, R.; Palomera, E.; Serra-Prat, M. (2006). "The ef
fect of bolus
viscosity on swallowing function in neurogenic dysphagia".Alimentary Pharmacology & Therapeutics. Wiley. 24 (9):
1385–1394. doi:10.1111/j.1365-2036.2006.03118.x(https://doi.org/10.1111%2Fj.1365-2036.2006.03118.x) .

External links
Physiology: 6/6ch3/s6ch3_15- Essentials of Human Physiology
Overview at nature.com
Anatomy and physiology of swallowing at dysphagia.com
Swallowing animation (flash) at hopkins-gi.org
[Article on French Wikipedia] See : d
" églutition atypique" = unfunctional or pathological swallowing.

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