Swallowing

The swallowing is the action Avaler animal , the displacement of the chewed Nourriture until the Estomac. Swallowing proceeds in four times:

• oral time (voluntary swallowing or automatic)
• time pharyngien (swallowing reflex)
• time œsophagien
• cardiac time

oral time

Swallowing with vacuum

Salivary , and nonfood swallowing of the type, because it does not make following the Mastication

• one automatically swallows (Réflexe) 1500 to 2000 salivary bowls by twenty-four hours
• in the adult, a little less half thunders of saliva is swallowed per annum , that is to say 1,5 liters of saliva per day
• it is the most frequent function and most important of the apparatus manducator
• it allows the humidification oral mucous membranes and pharyngiennes
• it allows the drainage of secretions Nasal fossae and Rhinopharynx
• it allows the ventilation middle ear by opening of the Eustachian tube
• by this opening of the Eustachian tube, salivary swallowing allows the balancing of the pressures on each side of the membrane of the Tympan

typical swallowing

• the posterior language rests on the osseous Palais and against the posterior wall of the pharynx
• rise in the Os hyoïde and the Velum
• the mandible is stabilized in occlusion (by isometric contraction Réflexe of the muscles masticateurs)

atypical swallowing

• the language rests little on the osseous Palais: the lingual block exerts an impulse between the dental arches, higher and lower
• from this lingual interposition interarcades, the mandible is not stabilized in dento-dental occlusion: very limited contraction of the muscles masticateurs
• very energetic contraction of the muscles perish-oral examinations, or facial muscles
• atypical swallowing relates to more than 75% of the adult population
• syn. infantile swallowing (it is normal in the infant and the child); dysfonctionnelle swallowing pathological of the adult (Malocclusion)

Liquid foods

2 phases the aspiration by contraction of the orbicular Muscle of the lips language intercalated between the 2 arcades dental inocclusion propulsion of the liquid by tension of the oral Floor: contraction of the muscles mylo-hyoïdien and genio-hyoid

Solid food, viscous or plastic

(1) point of the language to the top

separation of the food block in 2 parts against the osseous palate

loading of the part to swallow against the lingual back

(2) closing of the mouth

flexible lips

=> stable occlusion

(3) contraction of the lingual floor

by rise in the muscles mylo-hyoïdien and genio-hyoid

=> bilateral and symmetrical contraction

(4) contraction of the language

1/4 ant of the language against the osseous palate even area retro-incisor: catch of call

3/4 post form a sagittal gutter to the top

=> displacement of the food block of before behind

by waves of peristaltic standard contraction

(5) tension and rise in the velum

contraction of the internal and external muscles péristaphylins

(6) joining of the language against the velar palate

transport of the bolus towards the isthmus of the Gosier

(7) rocks of the language to the bottom and the arrear

(reflexogenic zone of Vassiliev: base lingual, velar pillars post and wall of the Oropharynx)

distance of the radix of the wall post of the fugacious pharynx

=> vacuum

(8) passive spacing of the pillars post of the pharynx

(9) sending of the bolus towards the isthmus pharyngien

(10) bringing together of the pilers post of the pharynx by contraction of the m pen-pharyngiens

(11) lowering of the velum against the radix

perfect occlusion of the rhinopharynx

Time pharyngien

Action of transit

(1) réappui of the language against the pillars post of the pharynx

(2) contraction of the muscles pen-pharyngiens

During the passage of the bolus enters the posterior pillars of the pharynx

bringing together of the posterior pilers

(3) contraction of the Muscle azygos

rocks of the luette upwards and the back

(4) relaxation of the velum

that Ci falls down like a veil on the language

(5) rise in the Os hyoïde upwards and before

by action of the muscles mylo-hyoïdiens, genio-hyoids, digastric and stylohyoid

(6) simultaneous rise in the Pharynx and the Larynx

application of the larynx against the lingual base

(7) the épiglotte is pushed back passively with the top of the Glotte

by rocker of the Language

(8) widening of the opening of the pharynx

action combined of the muscles pharyngiens-staphylins and pen-pharyngiens

the pharynx is shortened and widened: the bowl is grabbed

action complementary to a short contraction of the diaphragm

(9) contraction of the muscles constrictor of the Pharynx

higher muscle, lower means then

peristaltic contraction apart from gravity

(10) relaxation of the muscle crico-pharyngien

sphinctor pharyngo-œsophagien (or sphincter higher of the Esophagus)

(11) rhythmic contraction of the muscle crico-pharyngien

after passage of the bolus

(12) opening of the openings of the Eustachian tubes

by contraction of the external muscles péristaphylins

Orificielles occlusions Reflex S

Here, it is categorically necessary to distinguish the functions Réflexe S (automatics) from the voluntary functions (corticalized, will of the individual)

Occlusion of the antagonistic teeth

Allows to stabilize the jaw lower on the upper jaw: swallowing physiological or functional, known as " in teeth serrées" This occlusion of the lower teeth on the higher teeth does not exist during an atypical swallowing, or dysfonctionnelle swallowing: because of the lingual impulse interarcades

Occlusion of the isthmus of the gosier

Prevent the increase of the bolus in the oral cavity support of the base and the back of the language against the palate bringing together of the former pillars of the veil

Occlusion of the nasal fossae

Support of the language on the wall post of the pharynx support of the free edge of the veil against the membrane pharyngienne bringing together of the pilers post of the pharynx, the veil and the luette avoid the crossing of the choanes by the bowl

Occlusion of the larynx

Prohibited the access of the bowl to the trachea artery repression of the épiglotte by the root of the language dilation of the base of the language to the top of the glottis rise of the laryngé skeleton contracting of the glottis apnea of swallowing

Time œsophagien

It ensures the transfer of food of Sphincter Supérieur of Esophagus until the cardia thanks to a peristaltic wave which traverses from top to bottom esophagus (primary education peristalsis). The musculature œsophagienne is divided into two layers, longitudinal external and internal circulars. It is made up, in the first centimetres of the esophagus, by striated fibers which little by little are replaced completely by smooth fibers on the level of the lower half of the esophagus. The peristaltic wave utilizes the two muscular layers. The contraction of longitudinal fibers attracts the distal portion of a segment œsophagien to the meeting of the bolus. The circular fibers are slackened downstream from the bowl and contract upstream. The peristalsis œsophagien is slower than the pharyngé peristalsis: the speed of the wave œsophagienne is of 3 cm/s in the esophagus proximal and up to 5 cm/s in the lower third. The peristalsis œsophagien can be started independently of the pharyngé peristalsis: the distention of the walls œsophagiennes causes a peristalsis says secondary, apart from swallowing.

Contrary to pharyngé time, gravity plays a part in the transfer of the bolus in the esophagus. The liquids can reach the cardia several seconds before the peristaltic wave. The contractions œsophagiennes are fuller at the subject lying than at the subject upright. In addition to gravity, a second factor contributes to the propulsion of food in the thoracic esophagus. At the time of the inspiration, it created a depression intraluminale which attracts the bolus downwards.

The duration of time œsophagien is quite higher than the two preceding ones: 2 seconds for the liquids, 7 to 9 seconds for the solids.

External bonds

• Anatomy, physiology, exploration and pathology of swallowing, Memory of Dr. Karen PINACHYAN

August 1st

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