SLP1043_3rdShifting_E-Portfolio_MacaraegTanyaPoleen

STRUCTURES OF SWALLOWING SWALLOWING Swallowing is a multi-stage process ELEVATORS Occurs due to the following muscles 1.ORAL PREPARATORY PHASE is mastication. You would need to 1. MASSETER move it to oral transit phase Two layers: superficial, and deeper Ramus and Zygomatic attachment 2.ORAL PHASE Tendency to feel rigid You are cupping food (in between dorsum of tongue), you catapult by 2. TEMPORALIS pushing it back and propelling it to When you clench your jaw, there is a the oropharynx (pharynx should be contraction and bulging of the sealed as a whole and the nasal muscle. cavity; soft palate should be tensed and elevated to seal the 3. PTERYGOIDS velopharyngeal port so the bolus does Medial Pterygoid not end up in the nasal cavity) Attaches to lingual side (internally) Bolus - partially broken down food Pulls ramus of mandible more superiorly a.LARYNGEAL ELEVATORS Originates from sphenoid (central and You cannot swallow with open mouth internal to cavity) Your hyoid is pulled anteriorly and Pterygoid Plates- it's where the medial superiorly and the mandibular pterygoids come from elevators elevate and elevates the Lateral Pterygoid larynx Attachment to the condylar process of Aditus Laryngis (opening of larynx) mandible Covered by epiglottis to prevent A little bit more superior than the aspiration (pababang travel ng medial pterygoids bolus) Enables the protrusion and retraction of the mandible 3.PHARYNGEAL PHASE Excursion of the Larynx DEPRESSION Relaxation of the sphincter Occurs due to the ff muscles: Open esophagus by cricopharyngeus muscle (upper esophageal sphincter) 1. MYLOHYOID Salivary glands fan-like muscle that partially forms Voluntary Process: Bolus passes the floor of mouth through the pharynx, glottis closes the trachea 2. DIGASTRICUS Anterior and Posterior Belly; but acts Piriform sinuses - some of the bolus goes as one here and can go to the glottis, causing Move the mandible anteriorly and a aspiration little posteriorly 4.ESOPHAGEAL PHASE 3. GENIOHYOID Peristaltic waves *Clench your jaw From esophagus to stomach, the For you to move a certain structure, gastric juices and food travels you need to consider the muscles that REFLUX: stomach goes to esophagus, make it move and the muscles that larynx, pharynx oral and nasal cavity. act against it. Antagonist: Masseter Elevators

oral preparation stage muscles MUSCLES OF ORAL PREPARATION STAGE MUSCLE FUNCTION INNERVATION TONGUE MUSCLES Elevates hyoid and tongue V Mylohyoid Elevates hyoid and larynx; depress mandible XII Geniohyoid Elevates hyoid and larynx V and VII Digastrics Retracts tongue XII Genioglossus Elevates posterior tongue XII Styloglossus Narrow fauces; elevates posterior tounge IX, X and XI Palatoglossus Elevates hyoid and larynx VII Stylohyoid Elevates hyoid XII Hyoglossus Elevates hyoid XII Thyrohyoid Elevates tongue XII Superior longitudinal Depresses tongue XII Inferior longitudinal Flattens tongue XII Transverse Narrows tongue XII Vertical SOFT PALATE MUSCLES Elevates soft palate X, and XI Levator veli palatini Dilates eustachian tube V Tensor veli palatini Shortens soft palate X, and XI Musuculus Uvulae PHARYNGEAL MUSCLES Palatopharyngeus Constricts oropharynx to channel bolus X, and XI Salpingopharyngeus Elevates pharynx XI Stylopharyngeus Raises larynx IX Cricopharyngeus Relaxes esophageal orifice X, and XI Middle Constrictor Narrows pharynx X, and XI Inferior Constrictor Narrows pharynx X, and XI SWALLOWING ANjDouDrnYaSl PaHrtAicGleIA IN THE ELDERLY Choking can happen at any age due to problems with the swallowing process. Dysphagia, on the other hand, becomes more likely as people become older. The aforementioned ideas are related to the journal of Jungheim, et. al. (2014) as it is attributable to a higher prevalence of disorders that induce dysphagia, as well as age-related alterations in swallowing mechanics. Aging has an impact on all of the anatomic components involved in swallowing. Mastication is limited, the swallowing reflex is delayed, the pharyngeal structures expand, the pharyngeal propulsion is protracted, the pharyngeal sensitivity is lost, the esophageal wall stiffness increases, and the esophageal contractility decreases. Presbyphagia refers to changes in swallowing function induced solely by age. Presbydysphagia arises when these alterations are so severe that they can no longer be compensated for. Presbyphagic and presbydysphagic alterations in the swallowing process must be evaluated for diagnostic and therapeutic purposes, and these must be distinguished from other non-age-related causes of dysphagia.

UNIT SIX: SWALLOWING - MUSCLES OF HEAD AND NECK ACTIVITY Mastication and deglutition can be viewed behaviorally or as a system of reflexive responses. The behavioral stages of mastication and deglutition include the oral preparatory, oral, pharyngeal, and esophageal stages. Muscles of Facial Expression Muscles of the Upper Mouth

UNIT SIX: SWALLOWING - MUSCLES OF HEAD AND NECK ACTIVITY Mastication and deglutition can be viewed behaviorally or as a system of reflexive responses. The behavioral stages of mastication and deglutition include the oral preparatory, oral, pharyngeal, and esophageal stages. Muscles of the Lower Mouth Muscles of Mastication

UNIT SIX: SWALLOWING - MUSCLES OF HEAD AND NECK ACTIVITY Mastication and deglutition can be viewed behaviorally or as a system of reflexive responses. The behavioral stages of mastication and deglutition include the oral preparatory, oral, pharyngeal, and esophageal stages. Laryngeal Muscles Mandible Depression Neck Muscles

UNIT SIX E-PORTFOLIO reflection SWALLOWING Us, students, have mastered the skill of harnessing the roles of anatomical parts and their physiology for speaking. Mastication, the process of preparing food for swallowing and deglutition, the processes of swallowing physiology provides an amazing glimpse of those interconnected systems we use so readily in speech. As we go over these very basic and fundamental processes, I noticed that the previous discussed topics such as the respiratory, phonatory, and articulatory systems all play a big role for day to day activities, like eating. Unit six has unlocked the idea of interconnecting and relating each of the previously discussed units on to one specific action, which is swallowing. Respiration is reinitiated during the second of the pharyngeal phase of swallowing. I remembered a joke from when I was back in elementary, that you cannot breathe while your tongue is stuck out. Now, if you're reading this and you've tried it subconsciously, I have tricked you into looking like a dog. lol. Going back to the topic, the articulatory and phonatory muscles and organs are used in the process of the swallowing phases. I have never been so excited about the thought of eating, and having to learn about it in this unit has made me more aware of the idea of swallowing. We've had this activity of timing the how long it took a person to swallow, and mind you I did not inform my dad that I'll be observing him so that he would not be to conscious. At first, it felt like it took him a long time to chew his food but eventually, I finished the activity. It's not my first time to encounter with the level of liquid and food consistencies because I've learned to like the program of Nutrition and Dietetist. Anyway, it's nice to encounter this things for the reason that it's part of your daily living, in the sense that 'woah okay' you suddenly become conscious about the way that people eat or whatsoever. Fun fact, this was also the first time I've encountered with the term 'bolus', during the asynchronous class video lecture, the first thing that came into my mind was that it was extra rice or 'bulos' as what we call. Anyway, I really had a good time with the 'eating' portion of the class, because it was somehow educational as well. You enjoy your food and also get to learn from it.

HEAD AND NECK EMBRYOLOGY 7

THE GENERAL HUMAN EMBRYOLOGY Placenta For gas exchange Why study Human Embryology? Exchange of nutrients and electrolytes Development of organs and structures Transmission of maternal antibodies Identify potential breakdown or etiology (passive immunity) of speech and/or language problems Production of hormones Filtration and detoxification of blood Timeline of Human Development Amniotic fluid (amnion) – large sac Week 1-2 where fetus is suspended in fluid and Start of fertilization connected to placenta via umbilical cord Zygote Helps absorb mechanical forces Morula Allow fetus to move Blastocyst Prevents embryo from adhering to Implantation surrounding tissues Trophoblast (inner: cytotrophoblast, outer: Birth Defects or Teratology syncytiotrophoblast) Genetic factors Embryoblast: (epiblast and Environmental factors hypoblast) Most are multifactorial Week 3 to 8 Gastrulation – establishment of 3 Teratogens germ layers Infectious agents Notochord formation Physical agents Neurulation Chemical agents Neural chest Hormones 3 germ layers Endoderm – give rise to structures Infectious Agents that Rubella Virus make contact to the outside world Cataracts, glaucoma, heart defects, Mesoderm - [paraxial hearing loss, tooth abnormalities (somitomeres), Cytomegalovirus intermediate, lateral] Microcephaly, visual impairment, Ectoderm intellectual disability, fetal death Herpes simplex virus Month 3 to 8 Microphthalmia, microcephaly, retinal Development of face dysplasia Rapid length increase Varicella virus Fetal motion (kicking) Skin scarring, limb hypoplasia, Wrinkled skin, fused CNS – respiratory intellectual disability, muscle atrophy system Toxoplasmosis Hydrocephalus, cerebral calcifications, Month 9 microphthalmia Increase in head circumference Syphilis Intellectual disability, hearing loss

Physical Agents Alcohol X-rays FAS, short palpebral fissures, maxillary Microcephaly, spina bifida, cleft hypoplasia, heart defects, intellectual palate, limb defects disability Hyperthermia Anencephaly, spina bifida, intellectual Isotretinoin (vitamin A) disability Isotretinoin embryopathy: small, abnormally shaped ears, mandibular Chemical Agents hypoplasia, cleft palate, heart defects Thalidomide Limb defects, heart malformations Industrial solvents Aminopterin Spontaneous abortion, prematurity, Anencephaly, hydrocephalus, cleft lip low birth weight, heart, cranio-facial and palate and neural tube defects Diphenylhydantoin (phenytoin) Fetal hydantoin syndrome: facial Organic mercury defects, intellectual disability Neurological symptoms similar to Valproic acid those of cerebral palsy Neural tube defects: heart, craniofacial and limb anomalies Lead Trimethadione Growth retardation, neurological Cleft palate, heart defects, urogenital disorders and skeletal abnormalities Topamax (topiramate) Hormones Cleft lip and/or cleft palate Androgenic agents Lithium Masculinization of female genitalia: Heart malformations fused labia, clitoral hypertrophy SSRIs (ethisterone, norethisterone) Heart malformations, neural tube Diethylstilbestrol (DES) defects, anal atresia, facial clefts and Malformation of uterus, uterine tubes, many other defects and upper vagina; vaginal cancer; Opioids (codeine, hydrocodone, malformed testes oxycodone) Maternal diabetes Neural tube defects, heart defects, Various malformations; heart and gastroschisis neural tube defects Amphetamines Maternal obesity Cleft lip and palate, heart defects Neural tube defects, heart defects, Warfarin omphalocele Skeletal abnormalities (nasal hypoplasia, stippled epiphyses) a timelineFETAL DEVELOPMENT ACE inhibitors Growth retardation, fetal death Mycophenolate mofetil Cleft lip and palate, heart defects, microtia, microcephaly

HEAD AND NECK EMBRYOLOGY Pharyngeal Arch Development 1st Pharyngeal Arch The development of the head, face, and Maxillary process neck is an area of embryology where Dorsal region significant strides in our understanding Extends beneath eye region have been made in the last few years. Gives rise to premaxilla, maxilla, All four embryonic germ layers contribute zygomatic, and portions of to the pharyngeal arches and their temporal bone derivatives, hence to further development Mandibular process of the head and neck. Contains Meckel’s cartilage Musculature Pharyngeal Arches Digastricus anterior Appear in 4th to 5th week Mylohyoid Consist of mesenchymal tissue Tensor tympani separated by pharyngeal clefts Tensor veli palatini Give rise to head and neck structures Nerve supply 1st, 2nd, 3rd, 4th, and 6th arches Mandibular branch of Trigeminal Outpocketings that appear along lateral nerve (CN V) wall Recognizable Prominences of pharynx Mandibular prominence Penetrates surrounding mesenchymal Maxillary prominence 4 pairs, give rise to important organs Frontonasal prominence Pharyngeal Pouches Mesenchyme Outpocketings of foregut and Derived from: primordium of thyroid gland and Neural crest aortic arches Lateral plate mesoderm Meckel’s Cartilage Paraxial mesoderm Disappears except for 2 small portions at dorsal end Neural Crest Migration Path Becomes malleus and incus From forebrain, midbrain, and hindbrain 2nd Pharyngeal Arch to their final locations Hyoid Arch Epipharyngeal placodes assist formation Cartilage gives rise to stapes, styloid of CN V, VII, IX, X sensory ganglia process, stylohyoid ligament, and ventrally lesser horn and upper corpus artery 1st arch Musculature and nerve supply nerve Stapedius cartilage pharyngeal cleft Stylohyoid pharyngeal pouch 2nd arch Digastricus posterior Facial Nerve (CN VII) ectoderm 3rd arch Reichert’s Cartilage endoderm Also from 2nd arch laryngeal opening Divides; one more ventral (hyoid to spinal cord lesser horn), one dorsal (stapes and styloid process)

3rd Pharyngeal Arch Pharyngeal Clefts Structure Between the arches are pouches Cartilage gives rise to greater horn internally and clefts externally and lower corpus of Hyoid bone Dorsal part of 1st cleft penetrates to form Musculature and Nerve Supply External Auditory Meatus Stylopharyngeus muscle Bottom portion epithelial lining of meatus Glossopharyngeal nerve (CN IX) forms eardrum (tympanic membrane) 4th and 6th Pharyngeal Arch Tongue Development Cartilaginous Appearance Fuses to form thyroid, arytenoid, 4 weeks forms 3 swellings: corniculate, and cuneiform 2 lateral lingual swelling cartilages Tuberculum impar Musculature and Nerve Supply Originate from 1st Pharyngeal Arch 4th arch (superior laryngeal Second median swelling (copula or nerve) hypobranchial eminence) formed by Cricothyroid mesoderm of 2nd, 3rd, partial 4th Levator veli palatini arches Pharyngeal constrictors Third median swelling from posterior 6th arch (recurrent laryngeal nerve) 4th arch forms epiglottis Intrinsic laryngeal muscles Behind is laryngeal orifice with arytenoid swellings lateral to it The Pharyngeal Pouch Development Fusion of lateral swelling and 1st Pharyngeal Pouch tuberculum impar forms anterior 2/3 Structures of tongue (body) Forms tubotympanic recess which Sensory innervation by mandibular forms future external auditory branch meatus CN V Distal portion widens to form Body of tongue is separated from middle ear (tympanic) cavity posterior Proximal portion forms Eustachian 1/3 via v-shaped terminal sulcus tube Epiglottis and posterior most portion 2nd Pharyngeal Pouch innervated by superior laryngeal Structures nerve Forms primordium of palatine Root or posterior 1/3 comes from 2nd, tonsils 3rd, 4th pharyngeal arches Remains to be tonsillar fossa Innervated by CN IX 3rd Pharyngeal Pouch Tongue musculature innervated by CN Structures XII hypoglossal nerve Dorsal region forms inferior Special sensory innervation (taste) to parathyroid gland anterior 2/3 provided by chorda Ventral regions forms thymus tympani of CN VII gland 4th Pharyngeal Pouch Structures Forms superior parathyroid gland

Facial Structures Intermaxillary Segment Appearance Appearance Facial prominences appear from 1st Medial growth of maxillary pharyngeal arch by 4th week prominences lead to formation of Maxillary prominence lateral to intermaxillary segment stomodeum Continuous with rostral portion of Mandibular prominence caudal to nasal septum formed by frontal stomodeum prominence Frontonasal prominence cephalic to Composed of: stomodeum. With nasal placodes Labial component – forms (precursors of nares) philtrum Nasal placodes transform to nasal Upper jaw component – location of pits 4 incisors Creates ridge: nasal prominence Palatal component – forms Lateral nasal prominence primary palate Medial nasal prominence Next 2 weeks: Secondary Palate Increase size of maxillary Appearance prominence Formed by palatine shelves from Grow medially compressing maxillary prominences which appears medial nasal prominence leading in 6th week to fusion Directed obliquely downward on each Upper lip formed by 2 maxillary side of tongue and 2 medial nasal prominences By 7th week, palatine shelves ascend Mandibular prominences merge to attain horizontal position above midline and form jaw and lower lip tongue Maxillary and lateral nasal Fusion results to forming secondary prominences separated by palate nasolacrimal groove Fusion point of primary and Solid epithelial cord from nasolacrimal secondary palate is the incisive groove forms nasolacrimal duct foramen Widening of upper end forms lacrimal Nasal septum grows downward and sac fuses with superior portion of Cord detaches so that maxillary and secondary palate lateral nasal prominence fuses fused medial together nasal folds Enlargement of maxillary prominence leads to formation of cheeks (buccae) and maxillae Nose formed from the 5 facial prominences Frontal – bridge Merged medial nasal – crest and tip Lateral nasal – sides (alae) nasal septum

Nasal Cavities Growth of dental cap leads to bell Appearance stage (bell appearance) During 6th week Dental papilla differentiate into Nasal pits deepen odontoblasts Oronasal membrane separate pits Odontoblasts produces dentin making from primitive oral cavity up dentin layer Forms primitive choanae Odontoblasts retreat to papilla leaving Formation of secondary palate dental process furthers development of primitive Remaining papilla cells form tooth nasal chambers pulp Definitive choanae lie at nasopharynx Inner dental epithelium differentiate into ameloblasts (enamel formers) Dental Development Clustering of ameloblasts will form Appearance enamel (regulates early tooth During 6th week development) knot Basal layer forms dental layer Enamel start to cover apex down to Lamina gives rise to dental buds neck Dental buds reach cap stage of Root forms epithelial that penetrate tooth development mesenchyme to form epithelial root Mesenchyme form dental papilla sheath Cap consists of layers: Chamber narrows and forms canal Outer dental epithelium containing blood vessels and nerves Inner dental epithelium Mesenchymal cells outside tooth Stellate reticulum (central core) comes in contact with root dentin to form cementoblasts Outside of cement layer, mesenchyme gives rise to periodontal ligament (position holder and shock absorber) Further lengthening of root will result to tooth eruption Buds for permanent teeth formed at 3rd month Oropharyngeal operations in children are prevalent. To be successful, Magreni and May (2015) stated that one must have a thorough grasp of the growing structures of the pediatric oral cavity. The diversion from normal embryologic development causes congenital abnormalities of these oral tissues. To comprehend the surgical approaches for correcting these congenital anomalies, it is necessary to grasp the embryology of the oral tissues. Children's oral cavity structures can change dramatically as they grow and mature into adults. Furthermore, understanding embryology can aid surgeons in better understanding how specific congenital defects develop, which can be beneficial in their therapy.

UNIT SEVEN E-PORTFOLIO reflectionHEAD AND NECK EMBRYOLOGY This section of the e-portfolio have discussed the embryology of the head and neck, alongside its development. In all honesty, I am part of the percentage that honestly do not like babies. Yes, they're sometimes cute, but most of the time, its a no for me. This unit was somehow weird for me, especially the development and progress of the embryo, now turned baby. Although, parts that discussed the formation of the facial structures did get my attention. To think that in four weeks time, a development from the nasal prominences start, and then the sixth progresses with the formation of the upper jaw, it seems like a pretty short time for me. Moreover, during outreach activities in my previous school, we got to hang out with mom's who've had use special substances during their pregnancy stages. It's very difficult for the child, as among the mother and the child, he/she receives the effects of the mother's substance abuse. Moreover, the development of the child is affected while the mother is still in pre-term, which means there's a possibility for it to die inside the womb. Specifically, understanding the concepts of the possible anomalies that could happen to the facial structures of the baby, calls the need for speech-language pathologists, especially if it concerns the cognitive communication, speaking, hearing and swallowing of one. All that said, I've realized how one's development inside the small 'tummy' as children would call it, could turn into as big as us right now. I've also realized that, five years ago as I've had a bad underbite, I've looked different from before than now; hence, the constant development of our facial structures. EMBRYjOouLrOnGalYaArtNicOleMALIES A thorough understanding of embryology and surgical anatomy enables the prediction of intraoperative results, resulting in safer and more effective treatment of patients with congenital neck deformities. This was elaborated in the journal of Todd (1993) on his Common Congenital Anomalies of the Neck: Embryology and Surgical Anatomy. Presumptive thyroglossal anomalies at or above the level of the hyoid necessitate special caution since the patient may lack thyroid tissue in the usual thyroid position. Dissection of the lingual mucosa is required due to the discontinuous nature of thyroglossal tracts, which is related to ontogenesis. Facial nerve anatomy is required for first branchial cleft cysts and fistulas; in some situations, the facial nerve is best detected in the temporal bone. Only physical relationships to cervical structures allow branchial cysts, sinuses, and fistulas to be assigned to a specific pouch-cleft.

anRatEomFyLaEnCd TphIyOsioNlog.y SPEECH-LANGUAGE PATHOLOGY As a future speech-language pathologist, the introduction of anatomy and physiology, and the discussion of it towards hearing is essential for us, as the investigation of a live being's structure through observation or examination. The ability to comprehend and understand the structure of organs, muscles, and bones, as well as their function, introduces us to the concept of human anatomy. Speech-Language Pathology concerns the study of human communication sciences and processes, which involves hearing, the ear. Life anatomy and physiology are included in the human investigation body. With that said, the human body can show non-obsessive anatomical irregularities known as variations, which should be able to be detected. Although technology allows us to see increasingly smaller details within the human body, we must still interpret what we see. Certain previously unseen structures will be difficult to spot, while others may be misinterpreted for disease. With all that said, I've gained a lot of information regarding the muscles of the human body when ti comes to speaking and even, eating. The thought of how such muscles move in their own directions, and are correlated amazes me. I hope future me will still be in awe just as how I am right now. Hey, if you're ever reading this, keep on going lang, you've come so far. - tanya poleen

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