Dietary adaptations including texture modification or preparation of food and liquids are aiming to avoid aspiration and make swallowing more efficient. It seems that combined treatment approaches would be beneficial, but much more work is necessary to improve the dysphagia management, and further well-designed future studies with larger patient cohorts of mildly to severely affected patients regarding dysphagia and PD stage, and focus on longer-terms are strictly needed to reveal more evidence on certain therapy outcome effects for PD-related oropharyngeal and also esophageal dysphagia. The structures involved in deglutition include the tongue, hard and soft palate, pharyngeal muscles, esophagus, and gastroesophageal junction.19 Coordination of swallowing is controlled by the trigeminal (CN V), facial (CN VII), glossopharyngeal (CN IX), vagus (X), and hypoglossal (CN XII) nerves and their nuclei. Discussion of pharyngeal motor function during deglutition would not be complete without discussing laryngeal swallow-related motor function that helps in transit of the swallowed food through the pharynx without invasion of the airway. The final stage of oropharyngeal deglutition is the pharyngoesophageal phase. This activity is myogenic in origin. Complications of dysphagia range from devastating consequences such as social isolation resulting from embarrassment of coughing or using compensatory strategies during eating (Robbins et al., 2006) to a wide variety of much more life-threatening sequlae. Novel technologies focus on invasive surgical interventions as well as on noninvasive experimental approaches that are intended to be used as alternative intervention or complementary to conventional dysphagia therapy. Swallowing is initiated when material is delivered to the pharynx. However, during exercise the unsupported cartilage moves axially and obstructs the rima glottidis.43, As mentioned earlier, during swallowing, the epiglottis pivots around its base, protecting the trachea. The crop acts as a temporary food storage site (Hill, 1971). The glosso-pharyngeal nerve (IX) and the pharyngeal branches of the vagus (X) innervate the pharynx and larynx, and their afferent and efferent pathways are co-ordinated in the swallowing centre in the brainstem. Impaction of the feed in the pharynx can sometimes cause stridor; in chronic cases, fetid breath and weight loss can occur. Below we will briefly describe the major anatomical and physiological components for each of the swallowing events, i.e., the oral, pharyngeal, laryngeal, and esophageal events, before elaborating on the topic(s) of swallowing disorders and related issues. The food bolus is transferred into the oropharynx by the base of the tongue. We use cookies to help provide and enhance our service and tailor content and ads. Because swallowing begins at the lips and ends at the stomach, a swallowing disorder (dysphagia) may become evident as a result of a disruption at any point along this route (Massey and Shaker, 1997). Regardless of which team member identifies the problem, it is appropriate and necessary that a referral be made to the speechlanguage pathologist. The sphincter closes after passage of the bolus to aid in retention and to prevent aerophagia. Central dopaminergic treatment using l-dopa (l-3,4-dihydroxyphenylalanine, levodopa) revealed inhomogeneous results on therapy effectiveness regarding swallowing functions, ranging from some improvement of beginning dysphagia symptoms during the first year after disease onset, over significant improvement of swallowing in the on-state comparing to off-state conditions, to no clear responsiveness at all, whereby for the bigger proportion of patients study results tend to no meaningful clinical improvement of swallowing, and moreover, different methodological quality can be found in the literature (Menezes & Melo, 2009; Muller et al., 2013; Warnecke, Hamacher, Oelenberg, & Dziewas, 2014). 2) Pharyngeal stage. It is the role of the speech-language pathologist to evaluate the patient, make the appropriate diagnosis and treat the dysphagia, if warranted. After partial gizzard filling, the esophago-ingluvial fissura is relaxed and food can either enter the crop or stomach depending on the contractile state of the gizzard. The deglutition center (swallowing center) are areas in the medulla and pons that respond to the incoming impulses by sending motor signals back to the pharynx and the upper esophagus (swallowing reflex). Once the food bolus reaches the pharynx, the involuntary pharyngeal phase begins. In addition to upward movement, because of subsequent approximation of arytenoids to the base of the epiglottis and epiglottal descent during swallowing, measurement of pure deglutitive vocal cord pressure, except for the brief initial phase, is at the present time virtually impossible. Swallow frequency can be increased and swallow latency can be decreased by gum chewing (South, Somers, & Jog, 2010), but no evidence could be revealed influencing the swallowing physiology in prandial context until now. Intratracheal pressure during coughing induced a pressure significantly higher than all other studied events (Δp < 0.05). Sameeh M. Abutarbush, in Robinson's Current Therapy in Equine Medicine (Seventh Edition), 2015. To close off the upper respiratory system from the lowers respiratory system 2. to move the bolus quickly through the pharynx preventing food from getting into the airway. Diagnosis of dysphagia requires intimate knowledge of the anatomy of the oral cavity and oropharynx as well as the neurologic control of this region. There are 3 stages or phases of deglutition. MASTICATION OR CHEWING CHEWING is a program of mandibular movements patterned in a sequence of distinctive recurring cycles. In late afternoon meals, the crop also fills (G. Duke, personal communication).