SLP1043_3rdShifting_E-Portfolio_MacaraegTanyaPoleen

UNPAIRED LARYNGEAL CARTILAGES EPIGLOTTIS Leaf-like structures that arises from the CRICOID CARTILAGE: Landmarks inner surface of the angle of the thyroid 1.Anterior cricoid arch cartilage just inferiorly from the notch provides clearance for the vocal folds because it is low and thinner in 1.Thyroepiglottic Ligament thickness compared to the posterior The attachment of the thyroid part of the cartilage ligament to the epiglottis enables clearance for the vocal folds to move Sides of the epiglottis are joined with the 2.Posterior quadrate lamina arytenoids or arytenoid cartilages via the provides posterior elevation to the aryepiglottic fold cricoid cartilage 2.Aryepiglottic Fold this is the reason why it is more elevated at the posterior end Product of membranous lining being the superior surface of the posterior draped over the muscle and quadrate lamina provides the point of connective tissue articulation for the arytenoid cartilages 3.Glossoepiglottic folds 3.Articular facets The epiglottis projects upward beyond located at the lateral surface of the the larynx and above the hyoid bone cricoid cartilage and is attached to the root of the marks the point of articulation for the tongue through the median inferior horns of the thyroid cartilage glossoepiglottic folds and the paired and thus forms the cricothyroid joint 4.Cricothyroid joint →lateral glossoepiglottic ligaments an arthrodial pivoting joint that permits rotation of the two structures 4.Valeculae/Valecula google says vallecula THYROID CARTILAGE: Landmarks Is produced by the median The thyroid cartilage is the largest of the glossoepiglottic folds and paired unpaired cartilages glossoepiglottic ligaments Very important landmark in 1.Thyroid laminae swallowing 2.Thyroid notch 5.Internal Laryngeal Nerve (CN X Vagus adam’s apple Nerve) More prominent in males than in Conducts sensory information to the females larynx particularly with the epiglottis 3.Oblique line the lateral superficial aspect of the 2 surfaces of the epiglottis: thyroid lamina 1.Lingual Surface it marks the attachment for 2 faces the tongue musculatures 2.Laryngeal Surface 4.Inferior cornua faces the larynx projects inferiorly to articulate with the cricoid 2 subdivisions of the epiglottis: 5.Superior cornua 1.Suprahyoid subdivision projects superiorly to articulate with has a free anterior surface the hyoid visibly seen 2.Infrahyoid subdivision not exposed or not visible

PAIRED LARYNGEAL CARTILAGES HYOID BONE ARYTENOID CARTILAGE: Landmarks Not a bone of the larynx, rather forms the Corniculate Cartilage union between the tongue and laryngeal Found on the superior surface of the structure arytenoid cartilages projecting Articulates loosely with the superior cornu posteriorly to form the peak of a of the thyroid cartilage distorted pyramid Only bone of the body that is not attached Base to other bones Inner surface of the cartilage U-shaped being open to the posterior The concave surface is the point of aspect articulation with the convex arytenoid The hyoid bone is suspended and not facet of the cricoid cartilage directly attached to any bone in the body Base is slightly wider than the apex Vocal Processes (2 projections) HYOID BONE: Landmarks Projects anteriorly toward the thyroid Corpus notch body of the hyoid bone Point of attachment for the posterior Prominent shield-like structure forming portion of the vocal cords the front/anterior aspect of hyoid bone Muscular Processes Palpable structure Projecting a little bit laterally Anterior portion is more convex Form the lateral outcropping of the Inner surface is more concave arytenoid pyramid Also a point of attachment of the Attachment of muscles that adduct different muscles of the neck (6 and abduct the vocal folds muscles) Greater Cornu cuneiform Arises on the lateral surface of the body that projects posteriorly arytenoid Larger horn Lesser Cornu base of the arytenoid Smaller horn Is at the junction of the corpus and CUNEIFORM CARTILAGE: Landmarks greater cornu Small cartilages embedded in the There are 3 muscles attached to these aryepiglottic fold situated above and cornua anterior to the corniculate cartilages Provide support for membranous greater cornu laryngeal covering Causes a small bulge in the surface lesser cornu membrane of the aryepiglottic folds that looks like a shiny white opaque translucent substance under illumination

LARYNGEAL JOINTS AND INNERVATIONS LARYNGEAL INNERVATIONS Classified or supplied by 2 particular 2 IMPORTANT LARYNGEAL JOINTS branches of the Cranial nerve 10 (vagus that functionally makes the larynx mobile nerve) in the junctions or attachments Superior Laryngeal Nerve Cricothyroid Joint Courses inferiorly and is called Junction of cricoid cartilage and “superior” because it is coming from inferior cornua of the thyroid cartilage the superior portion of the larynx Synovial or a diarthrodial joint that Supplies sensory to the structures permits the cricoid and the thyroid above the vocal folds and only has rotate and glide relative to each other one motor innervation (cricothyroid Rotation at the cricothyroid joint muscle) permits the thyroid cartilage to rock Internal Branch (sensory branch) down anteriorly Provides sensory supply above the (forms a similar movement when vocal folds you flex your neck when you bow External Branch (innervation branch) down) Supplies innervation to the Permits the thyroid to glide anteriorly cricothyroid muscle and slightly posteriorly relative to the cricoid cartilage Recurrent Laryngeal Nerve Provides the major adjustment for the “Recurrent” because it courses through change in vocal pitch inferiorly but comes back superiorly to innervate the lower structures Cricoarytenoid Joint Supplies efferent nerve fibers to all Joint formed between the cricoid and other intrinsic laryngeal muscles arytenoid cartilages except for the cricothyroid muscle Synovial or a diarthrodial joint that Supplies sensory innervations to the permits the rocking, the minimal structures inferior to the vocal folds rotating, and gliding of the arytenoid cartilages totosusummmmaarirzize:e: The arytenoid facet of the cricoid is a convex, oblong-like surface, and the The laryngeal cartilages have a number of axis of the motion is round important landmarks to which muscles are Rocking action brings the two vocal attached. processes together permitting the The cricoid cartilage is shaped like a signet vocal folds to do adduction ring, higher in back. Combinations of these movements, The arytenoid cartilages ride on the superior which are the adduction and surface of the cricoid, with the cricoarytenoid abduction, provide the mechanism for joint permitting rotation, rocking, and gliding. the vocal fold approximation The muscular and vocal processes provide attachment for the thyromuscularis and thyrovocalis muscles. Understanding the role of each of these muscles in producing vocal fold movement is necessary for better understanding of laryngeal biomechanics as well as the development of new treatments for neuromotor laryngeal disorders. When contracted with muscles that shorten the vocal folds, the intrinsic laryngeal muscles can be classified as adductors for vocal fold closing, abductors for vocal fold opening, or lengtheners for increasing vocal fold length or tension. (Poletto et al., 2004)

MUSCLES OF THE PHONATORY SYSTEM oblique arytenoid INTRINSIC MUSCLES modifies phonation the adduction and abduction functions are provided by muscles linked to the arytenoids, which allow us to adjust the amount of airflow through muscular contraction. ADDUCTORS Lateral cricoarytenoid, transverse transverse arytenoid arytenoid, oblique arytenoid Put the vocal folds in the midline. MUSCLE: LATERAL CRICOARYTENOID posterior lateral ORIGIN: Superior-lateral surface of the cricoid cricoarytenoid cricoarytenoid cartilage COURSE: Superior-posteriorly INSERTION: Muscular process of the ABDUCTORS arytenoids Pulls away from midline (opens) INNERVATION: CNX (10 - vagus nerve), Only one muscle abductor recurrent laryngeal nerve branch Posterior cricoarytenoid FUNCTION: Adducts vocal folds; increase Since arytenoids are capable of gliding medial compression on the long axis of the facet, the INTERARYTENOIDS abduction will also be permitted because of the posterior MUSCLE: TRANSVERSE ARYTENOID cricoarytenoid muscle. ORIGIN: Lateral margin of the posterior arytenoid surface MUSCLE: POSTERIOR CRICOARYTENOID COURSE: Laterally ORIGIN: Posterior cricoid lamina (specifically INSERTION: Lateral margin of the posterior the posterior quadrate lamina of the cricoid) surface; opposite arytenoid COURSE: Superiorly INNERVATION: CNX (10 - vagus nerve), INSERTION: Posterior aspect of the arytenoids recurrent laryngeal nerve branch INNERVATION: CNX (10 - vagus nerve), FUNCTION: Adducts vocal folds recurrent laryngeal nerve branch FUNCTION: Rocks arytenoids cartilage MUSCLE: OBLIQUE ARYTENOID laterally which then abducts the vocal folds ORIGIN: Posterior base of the muscular when it contracts process * Vocal folds must be adducted, and abducted at a COURSE: Superiorly and obliquely full range of laryngeal adjustment is possible INSERTION: Apex of the opposite arytenoids INNERVATION: CNX (10 - vagus nerve), * From completely abducted to tightly adducted: use recurrent laryngeal nerve branch of range during phonation and bulk of voice complaints FUNCTION: Pulls the apex medially will arise from inadequate control of this musculature.

MUSCLES OF THE PHONATORY SYSTEM Thyrovocalis INTRINSIC MUSCLES modifies phonation Tensors, Relaxers, and Auxiliaries TENSORS Tenses the vocal fold 2 types: Thyrovocalis and Cricothyroids (cricothyroids have 2 subtypes) Cricothyroid MUSCLE: THYROVOCALIS Thyromuscularis ORIGIN: Inner surface, Thyroid cartilage near notch RELAXERS COURSE: Posteriorly MUSCLE: THYROMUSCULARIS INSERTION: Lateral surface of the arytenoid ORIGIN: Inner surface of the thyroid cartilage vocal process near the notch INNERVATION: Recurrent laryngeal nerve COURSE: Posteriorly branch, CN X Vagus INSERTION: Base and muscular process of FUNCTION: Tenses vocal folds arytenoid cartilage INNERVATION: Recurrent laryngeal nerve, CN INTERARYTENOIDS X - Vagus nerve FUNCTION: Relaxes vocal folds MUSCLE: CRICOTHYROID - PARS RECTA ORIGIN: Anterior surface of the cricoids Pars Recta cartilage beneath the arch Part COURSE: Superior, externally INSERTION: Lower surface of the thyroid Oblique Part lamina INNERVATION: External branch of the superior REMEMBER: Thyroarytenoid Muscles are two muscles, laryngeal nerve of CN X - Vagus nerve which are the medial-tensor and lateral-relaxer) FUNCTION: Depresses thyroid relative to cricoid; tenses vocal folds MUSCLE: CRICOTHYROID - PARS OBLIQUE ORIGIN: Cricoids cartilage lateral to Pars Recta COURSE: Superiorly and obliquely INSERTION: Thyroid cartilage between laminae and inferior horns INNERVATION: External branch of the superior laryngeal nerve of CN X - Vagus nerve FUNCTION: Depresses thyroid relative to cricoid; tenses vocal folds

MUSCLES OF THE PHONATORY SYSTEM EXTRINSIC MUSCLES consists of muscles with one attachment INTRINSIC MUSCLES to a laryngeal cartilage. modifies phonation Tensors, Relaxers, and Auxiliaries LARYNGEAL ELEVATORS AUXILIARIES MUSCLE: DIGASTRICUS MUSCLES (ANTERIOR) Help in relaxation, abduction and ORIGIN: Inner surface of the mandible, near adduction of the vocal folds symphysis (around the chin area) Constriction of airway COURSE: Medially and inferiorly INSERTION: Into Hyoid, by means of MUSCLE: SUPERIOR THYROARYTENOID intermediate tendon ORIGIN: Inner angle of thyroid cartilage INNERVATION: CN V - trigeminal nerve, COURSE: Posteriorly mandibular branch, via the mylohyoid INSERTION: Muscular process of arytenoid branch of the inferior alveolar nerve INNERVATION: Recurrent laryngeal nerve, X FUNCTION: Elevate hyoid; draws hyoid Vagus superiorly and anteriorly FUNCTION: Relaxes vocal folds MUSCLE: DIGASTRICUS MUSCLES (POSTERIOR) MUSCLE: THYROEPIGLOTTIC MUSCLE ORIGIN: Mastoid process of temporal bone ORIGIN: Inner surface of thyroid at angle COURSE: Medial and inferior COURSE: Posteriorly-Superiorly INSERTION: Into lesser cornu of Hyoid, by INSERTION: Lateral Epiglottis (sides) means of intermediate tendon INNERVATION: Recurrent laryngeal nerve, X INNERVATION: VII facial nerve, digastric Vagus branch FUNCTION: Dilates airway; makes the FUNCTION: Elevate hyoid as well, but draws epiglottis instead of deflecting downward, it hyoid a little bit more posteriorly keeps it in place for it not to be in obstruction MUSCLE: STYLOHYOID MUSCLE MUSCLE: ARYEPIGLOTTIC MUSCLE ORIGIN: Styloid process of temporal bone ORIGIN: Continuation of oblique arytenoid COURSE: Medially and inferiorly muscle from arytenoid apex INSERTION: Corpus of Hyoid COURSE: Posteriorly-Superiorly as muscular INNERVATION: CN VII - Facial nerve component of Aryepiglottic fold FUNCTION: Move hyoid posteriorly INSERTION: Lateral Epiglottis (sides) INNERVATION: Recurrent laryngeal nerve, X MUSCLE: MYLOHYOID Vagus ORIGIN: Mylohyoid line, inner surface of FUNCTION: Constricts laryngeal opening; mandible closes/deflects epiglottis downward COURSE: Fan-like arrangement to median fibrous raphe and hyoid * Thyroepiglottic muscle has no apparent function INSERTION: Corpus of Hyoid in speech but is active in the pharyngeal phase of INNERVATION: Alveolar nerve, CN V - swallowing. Keeps either the epiglottis at its resting trigeminal nerve, mandibular branch position, or relaxes to give way to the aryepiglottic FUNCTION: Elevates hyoid or depresses muscle. mandible (if hyoid is in fixed position)

MUSCLES OF THE PHONATORY SYSTEM LARYNGEAL DEPRESSORS Infrahyoid Muscles EXTRINSIC MUSCLES AKA laryngeal depressors Muscles that come from the hyoid to LARYNGEAL ELEVATORS structures below the hyoid MUSCLE: GENIOHYOID MUSCLE: OMOHYOIDS, SUPERIOR BELLY ORIGIN: Mental spines, inner surface of ORIGIN: Intermediate Tendon mandible COURSE: Inferiorly COURSE: Posteriorly and inferiorly INSERTION: Lower border, hyoid INSERTION: Corpus of Hyoid INNERVATION: Superior ramus of ansa INNERVATION: CN XII - hypoglossal nerve cervicalis from C1 (mostly) and C1 spinal nerve FUNCTION: Depresses hyoid FUNCTION: Elevates hyoid or depresses mandible MUSCLE: OMOHYOIDS, INFERIOR BELLY ORIGIN: Upper border, scapula MUSCLE: HYOGLOSSUS COURSE: Superiorly and medially ORIGIN: Hyoid bone, particularly greater INSERTION: Intermediate tendon cornu, and corpus INNERVATION: Ansa cervicalis, spinal C2-C3 COURSE: Inferiorly FUNCTION: Depresses hyoid INSERTION: Sides of tongue INNERVATION: Motor branch of the CN XII - MUSCLE: STERNOTHYROID hypoglossal nerve ORIGIN: Manubrium sterni and first costal FUNCTION: Elevates hyoid when tongue is cartilage fixed; when hyoid is fixed, it depresses tongue COURSE: Superiorly and externally INSERTION: Oblique line, thyroid cartilage MUSCLE: GENIOGLOSSUS INNERVATION: XII hypoglossal and spinal ORIGIN: Inner surface of mandible at nerves C1 and C2 symphysis FUNCTION: Depresses thyroid cartilage COURSE: Superiorly, posteriorly, and inferiorly INSERTION: Tongue and corpus hyoid MUSCLE: THYROHYOID INNERVATION: Motor branch of the CN XII - ORIGIN: Oblique line, thyroid cartilage hypoglossal nerve COURSE: Superiorly FUNCTION: Elevates hyoid although it may INSERTION: Greater cornu, hyoid also have an effect to the tongue depending INNERVATION: XII hypoglossal nerve and on which structure is fixed fibers from spinal C1 FUNCTION: Depresses hyoid or elevates larynx MUSCLE: THYROPHARYNGEUS ORIGIN: Thyroid lamina and inferior cornu * When the larynx is elevated, this could help COURSE: Superiorly, medially elevate the sternum and the clavicle. INSERTION: Posterior pharyngeal raphe * When the sternum is fixed, it could pull both the (meeting point of pharyngeal constrictors) thyroid and the hyoid downward or inferiorly. INNERVATION: CN X - vagus, recurrent * The extrinsic muscles enable, with the nature of laryngeal nerve (external laryngeal) the hyoid bone, makes the larynx suspended with the FUNCTION: Constricts Pharynx and it may muscles acting as the sling of that suspended elevate the larynx bcos of constriction structure

musclesMaUssSocCiaLtEeSd OwFithTHlEarLyAnRgYeaNl Xfunction INTRINSIC EXTRINSIC Adductors Hyoid and Laryngeal Elevators Lateral cricoarytenoid Stylohyoid Transverse arytenoid Mylohyoid Oblique arytenoid Geniohyoid Genioglossus Abductor Hyoglossus Posterior cricoarytenoid Inferior pharyngeal constrictor Digastricus anterior and posterior Tensors Thyrovocalis (medial thyroarytenoid) Hyoid and Laryngeal Depressors Cricothyroid, pars recta, and pars oblique Sternothyroid Omohyoid Relaxers Thyrohyoid Thyromuscularis (lateral thyroarytenoid) Auxiliary Musculature larungeaLlAUmGuHscINleG activuty Superior thyroarytenoid Thyroarytenoid Aryepiglotticus Understanding the structure and function of the laryngeal mechanism is necessary for assessing phonatory function, analyzing the larynx and vocal folds, and determining the effects of aberrant changes or adaptations on voice production. According to Scott (2015), When it comes to the human voice, an individual has abilities like vocal impersonation, singing, beatboxing, and so on. However, a separate vocal behavior, like laughter, can effectively disrupt these voluntary motor movements. This was further supported by a journal article of Citardi, et al. (1996), the vocal folds were discovered to undergo rhythmic abduction and adduction during laughter. This was viewed through a telescopic and fiberscopic videolaryngoscopy which was used on five people who laughed in various vowels, at various frequencies, and with diverse voice characteristics to assess laryngeal function during laughter. All subjects were able to establish voluntary control of paramedian vocal fold location by the completion of these specific phonation trials. The laryngeal function during laughter was better defined in their study. Moreover, this means that when individuals laugh loudly, they begin to emit sounds that we would never hear in any other situation. If we are speaking, or attempting to speak, the effect of the laughter will be instantly obvious, as we begin to lose control over the muscles in our rib cage that normally work so precisely during speech. We don't do much extra to alter the sound of laughter – it's a really fundamental sound to make.

PROPERTIES OF VOICE VOCAL PITCH Perceptual correlate of frequency ( Hz ) VOCAL REGISTER Fundamental frequency or pitch is range of tones in the human voice determined by the mass, tension, and produced by a particular vibratory pattern length of vocal folds of the vocal folds. The higher the mass the lower the frequency and vice versa. DIFFERENTS TYPES OF REGISTERS: The greater the length of the vocal folds, Modal the higher the frequency The more tensed the vocal folds are, the register for regular speech higher fundamental frequency and vice Should match a person's age, gender, versa built or size of the speaker The more relaxed it is, the lower the fundamental frequency is (That’s why Falsetto pitch when we are stressed has a Increase in length and tension of the vocal tendency to be higher) folds Male has lower fundamental frequency Maintain longitudinal gap than females High pitch voice Commonly used in singing Vocal Pitch Issues A person with bigger built will have low Vocal/Glottal Fry sounding pitch voice Happens when there is a decrease in A person who is petite will have a high length of vocal folds sounding pitch voice Increased tension in lateral borders of the Reduced Pitch range - vocal fatigue vocal folds Experienced by singer Relaxed medial border of vocal folds Misuse of voice when they cannot Because of differences of tension and reach the higher pitches or notes. relaxation between the borders, Variable Pitch - the pitch variations is too unnaturally low pitched voice can be varied without patterns produced Monopitch - a person without changing Not normal for singing and speech the tone which may be caused by pathologies Whistle Register High-pitched sound squeaky, bird-like, The extrinsic laryngeal muscles also come and adds at least a half octave and often into play slightly during production of higher and much more to the upper range lower pitches (especially in untrained singers) The highest register in the female voice Conversely, if one can lower pitch similarly the and is rarely found in the male voice. larynx will lower. A good speaking voice does not Singers utilize this technique to sing in the apparently require much active muscle 5th, 6th, and 7th octaves involvement of the extrinsic laryngeal muscles. The posterior cricoarytenoid helps in the Trained singers keep the height of the larynx abduction of vocal folds and thyrovocalis nearly constant while singing a range of high cricothyroid which tenses the vocal folds and low notes (Sataloff, 1981). meant to increase the pitch

PROPERTIES OF VOICE VOCAL QUALITY Also known as harmonicity VOCAL LOUDNESS How voiced is produced smoothly Perceptual correlate of Intensity (dB) Clear and smooth voice In order for sound to be generated in Vocal folds should have symmetrical vocal folds, there should be pressure in mass, length and tension the vocal folds. If not symmetrical, one vocal fold will The higher the subglottal pressure, the vibrate differently and would produce higher the intensity and vice versa. different fundamental frequencies. People with low voices may have problems building up subglottal pressure. Diplophonia - wherein a person is generating There is a limit to how much pressure we two different fundamental frequencies or can generate normally. having two voices. Amplification devices are needed like megaphones to produce more pressure. Vocal folds should not come together too loosely because it will produce a breathy Primary Biomechanical Determinants voice. 1.subglottal pressure Person who speaks very tightly because 2.medial compression of the vocal folds the tension is very tensed and cannot 3.the duration, speed, and degree of vocal produced the normal vibratory pattern fold closure The vocal folds cover should move in 50 percent of the cycles. Vocal Loudness Issues The vocal folds should mirror each other's Cases where voices would be too soft like moverement. If does not happen, there whispering will be an increased gap and causes Cases where voices would be too loud or breathiness using loudness higher than the usual Monoloudness Vocal Quality Issues wherein a person talks in a consistent Hoarseness loudness Variable loudness can be characterized by breathiness no patterns which may be caused by Rough sounding voice pathologies Not smooth Sounds like it is breaking Hixon and Abbs (1980) have written: “Sound Strain pressure level, the primary factor contributing to Can be characterized by too much our perception of the loudness of the voice, is tension governed mainly by the pressure supplied to the suffocated larynx by the respiratory pump” Breathiness Too much air Great gap within the vocal fold covers The principles of changing voice quality are less well known than those of changing pitch or volume. The laryngeal articulator mechanism reconciles the concepts of voice quality as long-term, habitual postural settings in an accent and voice quality as the vibratory, phonatory portion of speech. It explains how multiple configurational adjustments and vibratory elements are achieved in the lower vocal tract. (Benner et. al, (2019)

UNIT FOUR: PHONATION ACTIVITY The creation of vocal sound and speaking is referred to as phonation. Although vocal expression appears to be effortless and simple, it is actually the result of a delicate and sophisticated system of laryngeal muscles and ligaments. The larynx is sustained in mid-air by a large sling of muscles that must work together to perform the complicated motions required for speech and non-speech functions. The larynx and its cartilages require both coarse and subtle adjustments to move. (Dumwright, King & Seikel, ., 2010) larySnPgEeaElCHvocAalNDfolNd OmNovSemPeEnEtCaHndGEmSuTscUleREaSctivity The activation of each of the laryngeal muscles was connected with laryngeal movement during diverse tasks such as sniffing, coughing, or clearing the throat, as well as speech syllable production, in order to better understand their involvement in causing vocal fold movement. Poletto et al. (2004) has stated in their journal that with bipolar hooked wire electrodes implanted bilaterally in four normal patients, the posterior cricoarytenoid, lateral cricoarytenoid, cricothyroid, and thyroarytenoid muscles were monitored through the nasoendoscope to record vocal fold movement and muscle activity at the same time. The posterior cricoarytenoid recordings all had a significant relationship with vocal opening, whereas cricothyroid activity only had a significant relationship with opening during sniffing. The thyroarytenoid and lateral cricoarytenoid activity were found to be significantly linked to the closure of the vocal folds during coughing. The patterning of laryngeal muscles that create vocal fold movement varied depending on the task; reciprocal muscle activity occurred during coughing, but speech and sniffing frequently featured simultaneous contractions of muscular antagonists. All that said, during respiratory, airway protection, and speaking duties, distinct combinations of muscle activation are used for biomechanical control of vocal fold opening and closing movements.

UNIT FOUR E-PORTFOLIO reflection PHONATION As human individuals, it is part of our daily life to talk, laugh, sneeze, yawn and so much more, all of which go through the process of phonation. It's not that complicated as I expected it to be and every single session I've had with the course has made me much more curious. Basically, the cricoid, thyroid, and epiglottis cartilages, as well as the paired arytenoid, corniculate, and cuneiform cartilages, make up the larynx. The cricothyroid joint connects the thyroid and cricoid cartilages, allowing the two cartilages to move closer together in front. A joint connects the arytenoid and cricoid cartilages, allowing for a wide range of arytenoid motion. The cartilages are then connected by ligament sheets and cords, and the medial-most surface of the larynx is covered with a smooth mucous membrane. Additionally, the vocal folds are made up of five layers of tissue, with the muscle of the vocal folds being the deepest. The intrinsic muscles of the larynx must work together to bring the vocal folds into and out of approximation. Increased tension, a function of the thyrovocalis and cricothyroid, raises vocal fundamental frequency. From that point, I've realised that as a singer the fact that I get to study this ideas, concepts and muscle activities make me more conscious. The principles of changing voice quality are less well known than those of changing pitch or volume. The laryngeal articulator mechanism reconciles the concepts of voice quality as long-term, habitual postural settings in an accent and voice quality as the vibratory, phonatory portion of speech. It explains how multiple configurational adjustments and vibratory elements are achieved in the lower vocal tract. Moreover, as a not-so professional singer, I've dealt with the paos, malat and hoarse voice because I kept on abusing my vocal folds. I've experienced having to rest my voice for almost two months after a solid fundraising concert, back then and the concept of the abuse of our voices made me much aware of how delicate this structures are. Phonation concerns more than how we view our voice and the larynx in terms of the individual's structures and capabilities as a tool for emotional expression, as well as its complex and wide-ranging function in spoken human communication.

ANATOMY AND PHYSIOLOGY OF RESONANCE AND ARTICULATION 5

ORAL PERIPHERAL Assessment of the anatomical and functional integrity of the structures that support speech MECHANISM EXAMINATION and swallowing (Stein and Fabus, 2011). Examination of a client’s oral cavity and surrounding areas ( Haynes and Pindzola, 2012). MATERIALS FOR OPM EXAMINATION: Light source (penlight or small flashlight) Wooden tongue depressors Sterile gloves Pads of cotton gauze Cotton swab Mirror * For more elaborate or specialized examinations, you may need more materials (flavor vials for taste sensation, bite blocks, and others) WHAT DO WE ASSESS? STRUCTURE SENSORY MOTOR 1.Integrity of structure and functions of the Discoloration Tactile Rate of following: Texture sensitivity motion Head and Neck Size Oral Rate of Face Symmetry stereognosis movement Jaw and Dentition Scarring Tactile Precision Lips Tissue localization Strength Tongue excess/ Two-point Endurance Hard Palate deficiency Soft Palate discrimination 2.Diadochokinetic rate (DDK) RATE can be classified to: measures how quickly you can Good, Fair, and Poor accurately repeat a series of rapid, alternating sounds called “tokens.” The tokens contain one, two, or three syllables, such as: “puh” “puh-tuh” Sensory * Ratings are based on Are the OPM structures sensitive? Can you feel the touch? a clinician’s experience Even though, we do not see anything, does the patient feel it? and internal Can feel and identify where? representation of Use fingers or cotton swab to touch patient and they can recognize if how strength and weaknesses many it is * Not a standardized Motor testing, no norms How far the movement of a certain structure? Speed of movement of structures Are the movement of structures right in the sense of over or under shooting? Can they sustain position with resistance to the opposing force? Usually use tongue depressor Can they maintain a certain movement without an opposing force?

OPM EXAMINATION - HEAD AND NECK Step by step OPM (Face): 1. Ask patient to close eyes, then, use a What is the posture of the head at rest? cotton swab to lightly touch parts of the Is there drooping of head or shoulders? face and ask the client if he/she can feel it 2. Ask patient to close eyes, then, use hands Ask the patient to shrug both to deeply touch parts of the face and ask shoulders while the clinician applies the client if he/she can feel it light pressure on each shoulder 3. Ask client to close and open her eyes Ask the patient to turn his head then provide resistance OPM EXAMINATION - JAW MUSCLES INVOLVED: Trapezius muscle (shrugging) What is the posture at rest? Examine the Sternocleidomastoid (head turning) size of the jaw in relation to the size of the INNERVATION upper part of the face. Is the jaw CN XI (Spinal Accessory Nerve) undersized or oversized? Step by step OPM (Head turning): Assess the range, speed, accuracy, 1. Turn head to the right and hold and symmetry of jaw movements 2. Turn head to the left and hold MUSCLE DEPRESSORS (Mandible): 3. Turn head to the right and hold, this time, Digastricus with resistance on the cheek Mylohyoid 4. Turn head to the left and hold, this time, Geniohyoid with resistance on the cheek Platysma MUSCLE ELEVATORS (Mandible): Step by step OPM (Shrugging): Masseter 1. Shrug shoulder and then hold Temporalis 2. Shrug shoulder and then hold, this time, Medial Pterygoid with resistance MOTOR INNERVATION: CN V (Trigeminal Nerve) OPM EXAMINATION - FACE ISSUES: Overall head size, the shape of the face, facial Feeding (Mastication) symmetry, and spacing of facial features Articulating (Shaping the vowels) Is there presence of drooping of the * Issues in closing and opening of the jaw may cheeks or the eyelids? cause issues in feeding such as mastication and issues in articulation such as for shaping the vowels Provide light touches to the face using a cotton swab or a finger Step by step OPM (Jaw): Provide deep touches on both left and 1. Ask the patient to slowly open the mouth right parts of the face 2. Ask the patient to move the jaw laterally Ask the client to close and open her 3. Ask the patient to maintain a closed jaw eyes in opposition to light downward pressure MOTOR INNERVATION: on the mandible CN VII (Facial Nerve) 4. Ask the patient to maintain an open jaw CN III (Oculomotor Nerve) position in opposition to upward pressure SENSORY INNERVATION: on the mandible CN V (Trigeminal Nerve)

OPM EXAMINATION - DENTITION Step by step OPM (Lips): 1.Provide light touch to lips using a cotton The teeth are contained within the alveoli swab to assess sensory function of the maxillae and the mandible 2.Ask the patient to pucker lips (/u/) We usually just assess the appearance of 3.Ask the patient to retract lips (/i/) our client’s dentition. 4.Ask the patient to purse lips. Use tongue depressor in between lips to assess labial Step by step AMR (Alternating Motor Rate): closure 1.Tell patient to tell /p/ multiple times (one 5.Ask the patient to puff out cheeks. Gently breath and perform as long as she can / squeeze one cheek, then both cheeks normal pitch and loudness) 2.Tell patient to tell /t/ multiple times (one OPM EXAMINATION - TOUNGE breath and perform as long as she can / normal pitch and loudness) Examine the size, surface, color, 3.Tell patient to tell /k/ multiple times (one completeness, and symmetry of tongue at breath and perform as long as she can / rest. normal pitch and loudness) Are there any fasciculations and Step by step SMR (Sequential Motor Rate): deviations at rest? 1.Tell patient to tell /pataka/ multiple times What is the color of the tongue? Are (one breath and perform as long as she white or red patches on the surface? can / normal pitch and loudness) Assess the lingual surface and frenum Assess the range of motion, endurance, OPM EXAMINATION - LIPS and strength of the tongue Assess the intrinsic and extrinsic muscles Observed the client’s lips at rest for of the tongue structure, symmetry, posture, and MOTOR INNERVATION: condition. CN XII (Hypoglossal Nerve) SENSORY INNERVATION: Is there evidence of cleft? CN V (Trigeminal Nerve) Is there a presence of drooling due to CN VII (Facial Nerve) poor labial closure/seal? CN XI (Glossopharyngeal Nerves) Assess the sensory function,labial range of motion, and labial seal and closure Step by step OPM (Tongue): Assess the integrity of the buccinators, 1.Ask the patient to protrude the tongue, obicularis oris, and muscles for lip then apply resistance depression and elevation 2.Ask the patient to retract the tongue, then MOTOR INNERVATION: apply resistance CN VII (Facial Nerve) 3.Ask the patient to depress the tip of the SENSORY INNERVATION: tongue CN V (Trigeminal Nerve) 4.Ask the patient to elevate the tongue tip /ta/ or /la/ * If there are issues in Lips, it might greatly 5.Ask the patient to elevate back of the affect the articulation of bilabial phonemes. tongue /ka/ or /ga/ (use bite block if Weak seal of the lip might cause food spillage. necessary) 6.Ask the patient to perform lateral movements, then apply resistance.

OPM EXAMINATION - HARD PALATE DIADOCHOKINETIC RATE Inspect the contour, ridges, and the width Assesses the client’s ability to make rapid of the hard palate alternating speech movements It increases as the child ages and declines Are there any scars, fistulas (opening in elderly after a surgery), or discoloration? Is Stimuli: there evidence of clefting? A blue tinge or translucent zone (zona Single, double, and/or triple syllabi as pellucida) should be noted as this can in “puh puh puh,” “puh-tuh puh-tuh,” indicate submucous cleft and “puh-tuh-kuh puh-tuh-kuh” Flow of testing of the Hard palate Step by step DDK: 1.Provide light touch to hard palate using a 1.Ask the client to repeat them as fast as cotton swab to assess sensory function possible. Use a stopwatch 2.Provide demonstration and allow practice OPM EXAMINATION - HARD PALATE 3.Ask the client to do it three times per stimulus Inspect the configuration of the soft 4.Measure by averaging the three trials palate and uvula. You may use the ff for quantitative measurements: Is the uvula deviated to any side? Are Count-by-time method there any fistulas or cleft? Fletcher Time by Count Method Is the uvula split (bifold)? Assess the muscles of the velum: the ARTICULATION AND RESONATION tensor veli palatini, musculus uvulae, levator veli palatini, palatoglossus, and Human Speech System palatopharyngeus Lungs - pump air up towards voice box MOTOR INNERVATION: and vocal tract CN X (Vagus Nerve) Voice box - vocal cords vibrate to form Except tensor veli palatini (CN V) voice SENSORY INNERVATION: Vocal tract - nasal cavity/oral cavity CN V (Trigeminal Nerve) resonate voice Step by step OPM (Soft Palate): Vocal Tract (Three Distinctive Parts) 1.Ask the patient to produce oral Pharyngeal Cavity - between the nasal consonants while a mirror is situated cavity and oral cavity, larynx and under the patient’s nostrils esophagus a.*(bababa, body, sassy, sees) Oral Cavity - where most of the 2.Gently pinch the patient’s nostrils closed articulators are located. ( teeth, tongue, during production of non-nasal sounds cheeks, palate ) 3.Ask the patient to stick out tongue and Nasal Cavity - aside from respiration, it produce high-pitched “Ah” while the also acts as the primary or the sole cavity clinician exerts light pressure on the blade for olfactory sensation of the client’s tongue with a tongue depressor or stimulate the gag reflex

THE SKULL BONES OF THE FACE Composed of 28 bones Mandible Some bones are paired (means that it Maxillae is found with one on the left and one Nasal bone on the right side of the body) and Palatine bone and nasal conchae some are unpaired. Vomer Zygomatic bone Have spaces that house certain organs Lacrimal Bone Hyoid bone Divide the bones of the skull based on its position: BONES OF THE CRANIAL SKELETON Cranium (8) Ethmoid bone Houses the brain Sphenoid Bone Ethmoid, sphenoide, frontal, occipital, Frontal bone parietals Parietal bone The most superior bones of the skull Occipital bone Temporal bone Bones of the face (14) Mandible, vomer, maxillae, nasals, ppaartrsts ooff tthhee sskkuullll palatines, lacrimals, zygomatics, inferior nasal conchae Orbits The more anterior bones of the skull Bony nasal septum Nasal conchae/turbinates Miscellaneous bones (6) Malleus, incus, stapes Upper, medial, inferior Landmarks Cavity is composed of several bones Three turbinate or concha within the nasal Frons, occiput, vertex cavity: Temporae (temples) upper, middle and inferior concha. Lateral sides of the skeel make way to form the nasal meatuses. Zygomatic arch (aka cheek bones) 6 pathways, 6 meatus 3 on each side. Foramen maxilla bone, the temporal bone, and exit holes or opening of the cranial the zygomatic bone nerves Anterior cranial fossae innervate the muscles within the area Frontal, ethmoid, sphenoid Cranial Sutures Middle cranial fossae fusion points of the bones that are Sphenoid, temporal, parietal adjacent to it. Posterior cranial fossae Coronal - separates frontal & parietal Sphenoid, parietal, temporal, occipital bones Foramen magnum Sagittal - separates the two parietal Serves as the opening and bones passageway of the brainstem and Lambdoidal - separates occipital bone spinal cord. & parietal bones External Auditory Meatus (found on Occipitomastoid - fuses occipital bone each side of the face) & mastoid portion of the temporal Styloid process - stylohyoid muscles bone come from the styloid process

FACIAL BONES MANDIBLE Jaw bone and is the largest facial bone MAXILLAE Anterior corpus Articulates with: ethmoid, frontal, inferior Mandibular rami nasal concha, lacrimal, opposite maxilla, Mental symphysis nasal, palatine, vomer, and zygomatic Mental protuberance bones Dental alveoli Second largest facial bone in size Mental Foramen Fuses in the midline just below the maxilla Mylohyoid line Posterior to the upper incisor Mandibular rami - 90 deg to corpus Anterior: coronoid process MAXILLA Posterior: condylar process Corpus Artic with Temporal bone from TMJ Frontal process - frontal bone and Mandibular notch zygomatic process Orbital process - creates inferior orbit of NASALS eye Paired Infraorbital foramen Form bridge of nose Alveolar processes - houses upper teeth Lie medially to frontal processes of maxilla Intermaxillary suture Articulate with: frontal bone, Continues between two upper central perpendicular plate of ethmoid, maxillae, incisors and between palatine septal cartilage processes and incisive foramen Nasal suture Canine eminence Nasal foramen may also exist on Palatine process one/noth bones anterior 3⁄4 of hard palate Nasal crest LACRIMALS Anterior nasal spine Smallest facial bones Proximal to lacrimal glands superior orbital Articulates with ethmoid, frontal, inferior fissure nasal conchae, maxilla Form portion of medial orbits of eyes supraorbital foramen lacrimal zygomaticofacial foramen mental foramen infraorbital foramen nasal cavity inferior nasal concha

PALATINE BONES CRANIAL BONES Paired, somewhat Posterior 1⁄4 of hard palate + portion of FRONTAL BONE floor and lateral walls of nasal cavity Squamous Portion: forehead, anterior most Also help form inferior orbits of eyes portion of cranium Horizontal processes - form posterior Posterior border artic with parietal portion of hard palate bones Anterior border is serrated, arctic with Orbital Portion: superior orbits of eye and palatine process of maxillae eyebrow region Posterior border is free, POAtt for velum Metopic suture Artic with: each other, ethmoid, frontal, Articulates with 12 bones: ethmoid, inferior nasal conchae, maxillae, vomer sphenoid, lacrimals, maxillae, nasals, parietals, zygomatics ZYGOMATIC BONES Frontal spine: located medially between Help form portion of lateral and inferior orbits of eyes walls of orbits of eye S to spine, immediately between two Corpus eyebrows is glabella Frontosphenoidal process L to glabella - supraorbital margins Orbital process Lacrimal gland fossa Maxillary process Ethmoidal notch Temporal process Frontal paranasal sinuses Zygomatic arch/cheekbone PARIETAL BONE INFERIOR NASAL CONCHAE Frontal Margin: coronal suture Found in each chamber making up nasal Sagittal Margin: sagittal suture cavity Occipital Margin: lambdoidal suture Articulates with maxilla and palatine Temporal Margin: squamosal suture Turbinate bones: superior and medial Outer surface: smooth nasal conchae + inferior nasal conchae Inner surface: grooves for blood vessels that pass through the meningeal layers of VOMER the brain Somewhat quadrilaterally shaped Middle meningeal vessel grooves Lower half of bony nasal septum Resides in horizontally oriented groov OCCIPITAL BONE (Posterior) created by nasal crests of maxillae Squamous portion Articulates with palatine bones and Lambdoidal margin - parietal perpendicular plate of ethmoid and Mastoid margin - temporal rostrum of sphenoid bone External occipital protuberance Posterior border is green Superior and inferior nuchal lines Anterior border articulates with Basilar portion cartilaginous nasal septum Foramen magnum: spinal cord passes through *Learning the landmarks, just like the Occipital condyles: Part of base of skull respiratory and phonatory systems, can to C1 atlas help you recognize the path and function of Hypoglossal canal the articulation muscles. Pharyngeal tubercle: superior most border of pharynx attache sto base of the skull Condylar fossa

TEMPORAL BONE ETHMOID BONE Sides of cranium Classified as bone of cranium, but also 2 Major parts contributes to facial part of skull Squamous portion: Cribriform plate Zygomatic process Partition between the nasal and Smooth cranial cavities Petrous portion Perforated by small openings Tympanic section Olfactory nerve Cochlea and semicircular Crista galli canals Housed within cranial cavity Mastoid section Anterior POAtt for falx cerebri Mastoid process (ACM origin) Perpendicular plate Mastoid air cells Articulates with frontal and nasal bones and vomer and rostrum of Mastoid section sphenoid Part: air cells diminish that remains is Cartilaginous nasal septum is bone marrow attaches to anterior perpendicular A and S part: air cells are progressively plate larger until they give way to the 2 ethmoidal labyrinths tympanic antrum Contain highly irregular air cells Upper limit of tympanic antrum is Present at birth tegmen tympanum Separated from medial walls of Roof of tympanic cavity orbits of eyes by lamina papyracea Styloid process Superior and middle nasal conchae In petrous portion to zygomatic SPHENOID BONE process Posterior to ethmoid and immediately POatt of three muscles and two anterior to foramen magnum and basilar ligaments portion of Occipital bone Mandibular fossa Depression on surface, between styloid 7 MAJOR PARTS and zygomatic processes Corpus Condylar process of mandible rests Anterior surface to posterior wall of within this fossa forming TMJ nasal Interior surface has small ridge called Parietal Bone Frontal Bone rostrum Hollow 2 chambers separated by midline septum, creating pairn of sphenoid paranasal sinuses Sphenoid Not present at birth, starts at year 3 Bone Note: all paranasal sinuses Lined with mucoperiosteum Drain into nasal cavity proper Sphenoid PS - spaces above Occipital Bone Ethmoid nasal conchae Temporal Bone Bone Frontal and maxillary: medial nasal meatus Ethmoid PS: nasal meatuses

Greater wings skull and face summary Part of superior, lateral and anterior TO SUMMARIZE walls of orbits Lateral margins arctic with zygomatic To conclude, the articulation structures bones are created by the intricate interaction of the bones of the face and skull. Lesser wings Interior surface: upper boundaries of The mandible houses the lower superior orbital fissures dental arch (lower set of teeth), as Anterior margins articulates with well as the alveolar area and the orbital plates of frontal bone tongue's resting place. Come together at the jugum The hard palate, site of attachment Posterior to jugum is the for the soft palate, alveolar ridge, chiasmatic sulcus upper dental arch, and major Sella trcica: houses pituitary gland, components of the nasal cavities are immediately posterior to chiasmatic all provided by the maxillae. sulcus The nasal septum is formed by the midline vomer articulating with the Pterygoid process ethmoid's perpendicular plate and Composed of 2 laminae the cartilaginous septum. Separated by pterygoid notch The cheekbone is formed by the Articulates with palatine bones zygomatic bone articulating with the anteriorly frontal bone and maxillae. The upper Lateral pterygoid lamina: POArt for nasal cavity is defined by the tiny medial and lateral pterygoid muscles nasal bones. Medial pterygoid lamina: terminates in With the prominent crista galli hamulus extending into the cranium and the perpendicular plate separating the Articulates with all other cranial bones nasal cavities, the ethmoid bone Contributes to orbits of eye + nasal and serves as the core of the skull and pharyngeal cavities face. Most complex of all cranial bones The lobes of the brain with the same Butterfly bone, since of the wings names are overlain by the frontal, parietal, temporal, and occipital THE ORAL CAVITY bones of the skull. The sphenoid bone is prominent Has 2 function: within the braincase, with the Biological function - primary function sphenoid's conspicuous greater and Mouth serves as the respiratory lesser wings situated lateral to the passageways and used for digestive corpus. The pituitary gland is housed processes in the hypophyseal fossa. Near the Mouth is used for mastication and foramen magnum, the clivus joins deglutition the occipital bone. Non Biological function - secondary function Mouth generates speech sounds and modify speech characteristics in the process of resonation

PARTS OF ORAL CAVITY CROWN Greater wings Lips Part of superior, lateral and anterior Rima oris ROOT walls of orbits Four layers of tissue Lateral margins arctic with zygomatic Cutaneous bones Muscular Deep Layer: muscle fibers in Lesser wings concentric rings Interior surface: upper boundaries of Superficial layer: receives superior orbital fissures muscles fibers from other facial Anterior margins articulates with muscles orbital plates of frontal bone Glandular Come together at the jugum Mucus Posterior to jugum is the Fat may also be deposited within chiasmatic sulcus these layers Sella trcica: houses pituitary gland, Inner surface: lips are anchored at immediately posterior to chiasmatic midline to the alveolar region and sulcus mandible by the superior and inferior labial frenulum Pterygoid process Landmarks: Composed of 2 laminae Vermillion zone Separated by pterygoid notch Transparency is created by Articulates with palatine bones abundance of eleidin in the anteriorly epithelium Lateral pterygoid lamina: POArt for Cheeks medial and lateral pterygoid muscles Buccae Medial pterygoid lamina: terminates in Similar in structure and are continuous hamulus with the lips Several facial muscles can be found in Articulates with all other cranial bones muscular layer of cheeks Contributes to orbits of eye + nasal and Within glandular layer: 5 or 6 glands pharyngeal cavities corresponding to molar region of teeth Most complex of all cranial bones Stenson's duct Butterfly bone, since of the wings Buccal fat pad Cheeks + lips + gums and posterior enamel teeth = buccal cavity Teeth dentine 32 (adult) , 20 (child) pulp Deciduous teeth > permanent teeth gum 4 basic types of teeth cementum Incisors: chisel-shaped, cutting and shearing food bone Cuspids/canines: tusk-like, ripping and tearing blood vessel Premolars: flat with broad surface, crushing and grinding nerve Molars: similar with premolars

A Typical Tooth The Development of Teeth Growth: tooth buds form along with External Surface enamel and dentin Crown: can be seen, approx. ⅓ of tooth Calcification: enamel and dentin harden Covered by enamel Eruption: teeth begin will begin to migrate Neck: generally at gum line into oral cavity Cementoenamel Joint Intraosseous Eruption: through bony Root: lies below gum line approx. ⅔ of alveolar ridge tooth Resorption: where osteoclasts Covered by cementum breakdown bone tissue within alveolar ridge and teeth begin Cementum: Approximately 50% minerals by to erupt weight. It is made up of minerals and is very Clinical Eruption: teeth cuts through porous. As opposed to the crown that is gingiva covered by enamel. Osteoblast reform the bone to create the alveoli Enamel: A very hard substance and about Attrition: wearing down, takes place 90% minerals by weight throughout life Dentin: bulk of the solid portion of a tooth is Eruption of complete deciduous set is 14- located. 18 months The tooth is anchored within the dental Lower central incisors: 6 to 9 months alveolus by a periodontal ligament. Upper central incisors and upper lateral incisors: 8 to 10 months Gomphosis joint – this is the Continues until second molars erupt at articulation of the tooth and alveolus. 20 to 24 months Internal view When all deciduous teeth have It is hollow because it is where the pulp erupted, child will have 20 teeth: canal is located The pulp cavity is filled with dental 2 upper cuspids pulp (where nerve fibers and blood 2 upper first molars vessels make their way through the 2 upper second molars apical foramen) 2 lower central incisors 2 lower cuspids Depending on its type, a tooth can have any 2 lower first molars number of surfaces 2 lower second molars Mixed dentition stage: 6 years Contact surface Eruption: a bony partition separates Incisor – incisal edge the deciduous teeth from the Other teeth – occlusal surface that permanent teeth. At the appointed comes in contact with the surface of time, osteoclasts resorb bone the other tooth Deciduous lower central incisors are shred at 6 to 8 years Posterior surface (facing the oral cavity) – Deciduous second molars are shred at 10 lingual surface; faces the tongue to 12 years Anterior surface * Infants develop deciduous or shedding teeth Incisors and cuspids – labial surface (aka. milk teeth) that give way to the permanent Premolars and molars – buccal teeth that must last a lifetime. surface Adjacent teeth have approximal surfaces Mesial surface – faces toward midline Distal surfaces – faces away midline.

Permanent set of teeth *adapted from Anatomy and Physiology for Speech, Lower central incisors, and upper and Language and Hearing by Siekel et. al. (2010) lower first molars at 6 to 7 years Eruption continues for anterior to posterior Eruption of permanent teeth: 11 to 19 years Upper and lower third molars ( wisdom teeth ): mid 20s 32 permanent teeth Successional teeth Superadded teeth Roots 1: incisors, cuspids, bicuspids Upper first bicuspids may have two roots 2: lower molars 3: upper molars Occlusal surfaces Bicuspids and molars are flatter than incisors and cuspids Cusps Bicuspids: 2 First molars: 4 Second molars: 3-4 Third molars: 3 First consonant sounds: 6 to 9 months Labial /p/, /m/, or alveolar /t/, /d/, /n/ First primary teeth emerge between 6 to 10 months Labiodental /f/ ( 30 to 36 months ), /v/ ( 48 months ) Linguodental /th/ sounds ( 54 - 60 months ) denNtiOtiToEnS nToOtesREtMo ErMemBeEmRb: er Dental development clearly parallels that of the individual. The permanent teeth that replace deciduous teeth are called successional teeth. The third molar and bicuspids erupt in addition to the original constellation and thus are referred to as superadded.

Occlusion totosusummmmaarirzize:e: where the surface of mandibular and maxillary dental arches meet and how The teeth are positioned within the maxillae's they meet depends on the type of alveoli. occlusion. The incisors, cuspids, bicuspids, and molars are all part of the mandible. Types of occlusion Each tooth has a root and a crown, with Overbite - maxillary arch will be more enamel covering dentin on the crown's anterior than the mandibular arch surface. Underbite – mandibular arch will be more Each tooth has a medial, distal, lingual, anterior than the maxillary arch buccal (or labial), and occlusal surface; the Normal occlusion – mandibular and occlusal surface indicates how the teeth work maxillary arch are alighted with each in the omnivorous human dental arch. other when they are occluded or when the The deciduous arch appears clinically mouth is closed between the ages of six and nine months, Class 1 malocclusion – normal in terms of whereas the permanent arch appears first molar however there is a between the ages of six and nine years. misalignment between anterior teeth, Class I occlusion refers to the mandible's particularly the cuspids and bi cuspids natural alignment mandible and maxillae, Class 2 malocclusion (overbite) - whereas Class II malocclusion pertains to a maxillary arch will be more anterior than retracted mandible. A relatively protruded the mandibular arch mandible is classified as a Class III Class 3 malocclusion – maxillary dental malocclusion. arch is more posterior than the Individual teeth may be oriented incorrectly mandibular dental arch within the mouth. torsiversion, labioversion, linguaversion, distoversion, and Types of malocclusion mesioversion are all part within the Distoversion – more distally located from alveolus. the alignment of the dental arch Infraverted and supraverted teeth are those Infraversion – they are the surface or the that have not fully erupted or are too erupted. height of the crown is lower than the neighboring or the adjacent teeth TYPES OF OCCLUSION Labioversion- teeth is more twisted or rotated toward the labial surface normal occlusion class 1 malocclusion Mesionversion – Alignment more towards midline rather than along the dental arch class 2 malocclusion class 3 malocclusion Supravertion – opposite of infraversion. The crown is higher than the adjacent teeth. Torsiversion - rotation of the teeth more towards the buccal cavity or surface Joshi, et.al (2014) stated that the vulnerability of the face to inherent and extrinsic perturbations signifies risk of birth abnormalities in orofacial tissues. Skeletal malocclusion is caused by the prenatal development of the mandibular and/or maxillary growth being distorted. If skeletal malocclusion is not corrected, patients may develop dental abnormalities, bruxism, tooth crowding, trismus, and more.

Alveolar Ridge gingiva Is the bony part of the mandible and maxilla where alveoli (tooth sockets) hard palate reside Ridge continues behind U&L teeth and buccal mucosa is more prominent in the maxillary arch Layer of mucous membrane covers retromolar bony ridge trigone Continues with oral cavity tongue Hard Palate Bony part of ceiling of oral cavity, floor floor of the mouth of nasal cavity Formed by processes of four bones LEVleAvaTtOorR mMuUsScCleLsES Anterior ¾: palatine processes of maxilla MUSCLE: LEVATOR VELI PALATINI Posterior 1/4 : horizontal processes ORIGIN: Apex of petrous portion of temporal of palatine bones bone and medial wall of the Eustachian tube Posterior nasal spine cartilage Palatal arch INSERTION: Palatal aponeurosis of the soft Intermaxillary suture palate, lateral to musculus uvulae incisive foramen or canals INNERVATION: Pharyngeal plexus from the XI Covered by mucous membrane accessory and X vagus nerves Has a ridged part called palatine ACTION: Elevates and retracts the posterior rugae velum Rugae – Transversely oriented wrinkles MUSCLE: MUSCULUS UVULAE immediately behind alveolar ridge ORIGIN: Posterior nasal spines of the palatine Midline raphe – where the junction of bones and palatal aponeurosis the soft palate along with the INSERTION: Mucous membrane cover of the intermaxillary suture is. velum 1/5 of the population may have torus INNERVATION: Pharyngeal plexus of XI palatinus accessory and X vagus nerves Tissue surrounding it is likely to have ACTION: Shortens the soft palate bluish tint Soft Palate / Velum 3 layers Mucous membrane (most superficial) Muscle fibers Palatal aponeurosis (deepest) Lowers and relax: palatoglossus and palatopharyngeus Lowers and tenses: levator veli palatini Raises velum: musculus uvulae Uvula some people have bifid uvula wherein their uvula is split into two.

MUSCLE: TENSOR VELI PALATINI MUSCLES OF THE MOUTH ORIGIN: Scaphoid fossa of sphenoid, sphenoid spine, and lateral Eustachian tube wall Tongue INSERTION: Palatal aponeurosis Primary articulator, which moves the INNERVATION: Mandibular nerve of V most during speech and swallowing. trigeminal Major structure responsible for ACTION: Dilates the Eustachian tube modifying resonant characteristics of vocal tract MUSCLE: PALATOGLOSSUS ORIGIN: Anterolateral palatal aponeurosis 2 Primary Parts INSERTION: Sides of posterior tongue Blade (Dorsum) INNERVATION: Pharyngeal plexus from the XI consists of tip, front, and back accessory and X vagus nerves Longitudinal median sulcus that ACTION: Elevates the tongue or depresses the intersects with the sulcus terminalis, soft palate where foramen cecum resides (demarcation line between blade MUSCLE: PALATOPHARYNGEUS and root) ORIGIN: Anterior hard palate and midline of the Root soft palate base of the tongue INSERTION: Posterior margin of the thyroid Median and Lateral Glossoepiglottic cartilage folds (between (M) and (L) are INNERVATION: Pharyngeal plexus from XI small depressions important when accessory and pharyngeal branch of X vagus swallowing called valleculae, it is a nerve base-like structure that catches the ACTION: Narrows the pharynx; lowers the soft food during degluttition) palate If the tongue is pressed flat against the MUSCLE: SUPERIOR PHARYNGEAL CONSTRICTOR ceiling of the oral cavity, the tip will rest ORIGIN: Pterygomandibular raphe against the anterior teeth; dorsum will INSERTION: Median raphe of pharyngeal rest against the alveolar ridge; front aponeurosis will rest against the hard palate; and INNERVATION: XI accessory nerve and X vagus back will rest against the velum. via pharyngeal plexus Surface of the tongue has rough ACTION: Pulls pharyngeal wall forward; appearance due to papillae (filiform, constricts pharyngeal diameter fungiform, simple, vallate) kekeyytatakkeeaawwaayys s House taste buds Taste buds are there for us to The horizontally coursing tube get the gustatory sensation or representing the nasal cavities arises from identify the different tastes the nasopharynx, with the nasal and nasopharyngeal regions entirely dorsum of tongue separated from the oral cavity by elevation of the soft palate. styloglossus The shape and size of the oral cavity is altered through movements of the tongue genioglossus styloid and mandible, and the nasal cavity may process be coupled with the oral/pharyngeal cavities by means of the velum. hyoid bone hyoglossus

(Posterior) ⅓ is smoother in intrinsIiNcTRmINusScIlCesMoUfSCthLeEStounge appearance that (Anterior) portion MUSCLE: SUPERIOR LONGITUDINAL Several mucous glands + ORIGIN: Fibrous submucous layer near the lymphoid tissue (lingual tonsil) epiglottis, the hyoid, and the median fibrous Anteriorly on undersurface of tongue - septum lingual frenulum (attaches the tongue INSERTION: Lateral margins of the tongue and to the floor of the mouth) region of apex In some cases, the lingual frenulum INNERVATION: XII hypoglossal nerve is more anteriorly attached than ACTION: Elevates, assists in retraction, or the norm which is called Tongue- deviates the tip of the tongue tied or ankyloglossia. Outer surface of tongue - mucous MUSCLE: INFERIOR LONGITUDINAL membrane ORIGIN: Root of the tongue and corpus hyoid Inferior surface - thin mucous INSERTION: Apex of the tongue membrane INNERVATION: XII hypoglossal nerve Corium - basement layer of ACTION: Pulls tip of the tongue downward, connective tissue of mucous assists in retraction, and deviates the tongue membrane Dense, felt-like, “skeleton” of tongue MUSCLE: TRANSVERSE TOUNGE MUSCLES ORIGIN: Median fibrous septum Tongue as a Muscular Hydrostat: INSERTION: Side of the tongue in the Intrinsic Muscles submucous tissue housed completely within tongue INNERVATION: XII hypoglossal nerve Extrinsic Muscles ACTION: Provide a mechanism for narrowing originate outside tongue the tongue Relatively little skeletal support, aside from hyoid and corium MUSCLE: VERTICAL MUSCLES OF THE TONGUE Tongue has ability to change its shape ORIGIN: Base of the tongue and position without diminishing its INSERTION: Membranous cover volume in the process INNERVATION: XII hypoglossal nerve Acts like a fluid-filled structure that is ACTION: Pull the tongue down into the fl oor of incompressible (muscular hydrostat) the mouth Not really filled fluid but muscle tissue The Tongue - Extrinsic Muscles The Tongue - Intrinsic Muscles Responsible for gross positioning of Inferior longitudinal, superior longitudinal, tongue transverse, vertical Genioglossus, styloglossus, palatoglossus, All paired, because of fibrous middle hyoglossus septum Independent neural innervation and blood extrinsic muscles of the tounge supply EXTRINSIC MUSCLES Fibers of superior longitudinal muscles are confined primarily to mid-region, inferior MUSCLE: HYOGLOSSUS longitudinals can be found more laterally ORIGIN: Length of greater cornu and lateral body Responsible for refined tongue of hyoid movements and postures (elongating, INSERTION: Sides of the tongue between flattening, narrowing, shortening) styloglossus and inferior longitudinal muscles INNERVATION: XII hypoglossal nerve ACTION: Pulls sides of the tongue downPulls sides of the tongue down

MUSCLE: GENIOGLOSSUS The Mandibular Movements ORIGIN: Inner mandibular surface at the Elevation (closed) symphysis Masseter - most powerful muscle of INSERTION: Tip and dorsum of tongue and mastication, slow, has both internal corpus hyoid and external fibers INNERVATION: XII hypoglossal nerve Medial/Internal Pterygoid - plus ACTION: Anterior fi bers retract the tongue; masseter = mandibular sling posterior fi bers protrude the tongue; together, Temporalis - quicker, snapping action anterior and posterior fi bers depress the Depression (open) tongue Digastricus Mylohyoid MUSCLE: STYLOGLOSSUS Geniohyoid ORIGIN: Anterolateral margin of styloid process Lateral/external pterygoid INSERTION: Inferior sides of the tongue Protrusion - simultaneous contraction (M INNERVATION: XII hypoglossal nerve and L) pterygoid muscles ACTION: Draws the tongue back and up Retraction - simultaneous contraction of (Posterior) fibers of temporalis and MUSCLE: PALATOGLOSSUS (Anterior) belly of digastricus as well as ORIGIN: Anterolateral palatal aponeurosis the mylohyoid and geniohyoid muscles INSERTION: Sides of posterior tongue Lateralization - simultaneous contraction INNERVATION: Pharyngeal plexus from the XI of lateral pterygoid and (posterior) portion accessory and X vagus nerves of temporalis ACTION: Elevates the tongue or depresses the soft palate manMdiAbNuDlaIrBUmLAovRemMenUtSCmLuEsScles MUSCLES OF MASTICATION MANDIBLE MUSCLE: MASSETER Temporomandibular Joint ORIGIN: Zygomatic arch INSERTION: Ramus of the mandible and Arctic of condylar process of mandible coronoid process with mandibular fossa of temporal bone INNERVATION: Anterior trunk of mandibular nerve arising from the V trigeminal Indirect arctic because of separation ACTION: Elevates the mandible by articular meniscus Surfaces are covered by fibrocartilage MUSCLE: TEMPORALIS (devoid of vascular tissue) ORIGIN: Temporal fossa of temporal and Entire TMJ is encapsulated by articular parietal bones capsule INSERTION: Coronoid process and ramus Condyle held in place by INNERVATION: Temporal branches arising from temporomandibular, sphenomandibular, the mandibular nerve of V trigeminal stylomandibular ligaments ACTION: Elevates the mandible and draws it Ginglymoarthrodial joint back if protruded Vertical, anteroposterior, and transverse dimensions of movement MUSCLE: MEDIAL PTERYGOID ORIGIN: Medial pterygoid plate and fossa Joint Capsule INSERTION: Mandibular ramus Lateral ligament INNERVATION: Mandibular division of the V Sphenomandibular ligament trigeminal nerve ACTION: Elevates the mandible Stylomandibular ligament

MUSCLE: LATERAL PTERYGOID Mandibular Movements ORIGIN: Lateral pterygoid plate and the greater Protrusion wing of sphenoid Simultaneous contraction of Medial INSERTION: Pterygoid fovea of the mandible and Lateral Pterygoid INNERVATION: Mandibular branch of the V Retraction trigeminal nerve Simultaneous contraction of posterior ACTION: Protrudes the mandible fibers of temporalis and anterior belly of digastricus as well as the mylohyoid MUSCLE: DIGASTRICUS ANTERIOR and geniohyoid muscles ORIGIN: Inner surface of the mandible at Lateralization digastricus fossa, near the symphysisalatine Simultaneous contraction of the lateral bones and palatal aponeurosis pterygoid and posterior portion of INSERTION: Intermediate tendon to juncture of temporalis (on one side). If both sides, hyoid corpus and greater cornu just closing tension INNERVATION: Mandibular branch of V trigeminal nerve via the mylohyoid branch of FAUCIAL PILLARS the inferior alveolar nerve ACTION: Pulls the hyoid forward; depresses the Anterior (palatoglossal) and posterior mandible if in conjunction with digastricus (palatopharyngeal) faucial pillars posterior Within them are muscle fibers MUSCLE: DIGASTRICUS POSTERIOR Anterior/palatoglossal folds ORIGIN: Mastoid process of temporal bone Palatoglossus muscle fibers INSERTION: Intermediate tendon to juncture of hyoid corpus and greater cornu Posterior/palatopharyngeal folds INNERVATION: Digastric branch of the VII facial palatopharyngeus muscle fibers nerve ACTION: Pulls the hyoid back; depresses Tonsillar Fossa mandible if in conjunction with anterior space existing between these folds digastricus Mallampati Score MUSCLE: MYLOHYOID ORIGIN: Mylohyoid line, inner mandible INSERTION: Median fi brous raphe and inferiorly to hyoid INNERVATION: Alveolar nerve, arising from the V trigeminal nerve, mandibular branch ACTION: Depresses the mandible MUSCLE: GENIOHYOID ORIGIN: Mental spines of the mandible INSERTION: Corpus hyoid INNERVATION: XII hypoglossal nerve ACTION: Depresses the mandible Class 1: Complete visualization of soft palate Class 2: Complete visualization of uvula Class 3: Visualization of only the base of uvula Class 4: Soft palate is not visible at all

TONSILS Velopharyngeal Mechanisms: V-P Closure Levator veli palatini Lymphoid masses in the posterior limits of Bilateral contraction to lift velum the oral cavity toward the palatopharyngeal wall in Arranged somewhat in a circle (referred an angular fashion. From an pen angle to as Waldeyer’s ring) to slightly 20 degrees closure. Musculus uvulae Parts of the Tonsil Assists in elevating velum when a Lingual tonsil tighter seal is required (shorten velum, At the base of the posterior tongue, the elevates velum, increases the floor of Waldeyer’s ring thickness of velum throughout a Palatine tonsils portion outfits length) Lateral walls of Waldeyer’s ring People who have velopharyngeal Housed within tonsillar fossae of incompetence have difficulty in anterior and posterior faucial pillars making a tighter seal. Supratonsillar fossa Pharyngeal tonsils/adenoids Velopharyngeal Mechanisms: V-P Opening The ceiling of Waldeyer’s ring, found Velum is lowered by contraction of along the posterior pharyngeal wall in palatopharyngeus, palatoglossus, and to the velum region some extent, Tensor veli palatini Lymphoid Tissue Palatopharyngeus acts as sling Fight infection oriented in opposite direction of Levator veli palatini Why are there tonsils? With pharyngeal attachment stabilized Tonsils trap bacteria to protect the - vertical fibers of the upper respiratory tract palatopharyngeus pull down and back on velum Velopharyngeal Mechanisms With tongue stabilized - (if anchored) Responsible for: palatoglossus will also depress velum regulating communication between but with less force than oral and nasal cavities palatopharyngeus during contraction letting air flow either inhalation or Tensor veli palatini - minor role exhalation through the nose or mouth. (lowers velum slightly, flattens velum, digestive and speech functions applies tension to palatal aponeurosis) Velum + posterior pharyngeal wall Closed: velum is raised to approximate Other Functions of V-P Mechanism palatopharyngeal wall Assist in swallowing - activated during Open: velum and palatopharyngeal swallow, and spindles from palatoglossus wall are separated house special receptors for pharyngeal swallow reflex Possavant’s pad Phonation - as vocal folds vibrate, velum Bulging of the palatopharyngeal wall, present in some individuals →increases its height greater supraglottic Could be seen via nasendoscopy or →volume drop in supraglottic pressure so laryngoscopy that it remains less than subglottic pressure

MUSCLES OF FACIAL EXPRESSION MUSCLE: LEVATOR LABII ALAEQUE NASI SUPERIORIS Humans communicate primarily through ORIGIN: Frontal process of maxilla acoustic signals (speech), and also INSERTION: Mid-lateral region of the upper lip through facial expression. INNERVATION: Buccal branches VII facial nerve Non speech communication skills: ACTION: Elevates the upper lip Blinking, winking eye, raising and lowering eyelids, pursing lips, frowning, smiling. MUSCLE: ZYGOMATIC MAJOR (ZYGOMATICUS) ORIGIN: Lateral to the zygomatic minor on FACfaIcAiLalEXePxpREreSsSsiIoOnN mMuUscSlCesLES zygomatic bone INSERTION: Corner of the orbicularis oris MUSCLE: ORBICULARIS ORIS INNERVATION: Buccal branch of VII facial nerve ORIGIN: Corner of lips ACTION: Elevates and retracts angle of mouth INSERTION: Opposite corner of lips INNERVATION: VII facial nerve MUSCLE: DEPRESSOR LABII INFERIORIS ACTION: Constrict oral opening ORIGIN: Mandible at the oblique line INSERTION: Lower lip MUSCLE: RISORIUS INNERVATION: Mandibular marginal branch of ORIGIN: Posterior region of the face along the the VII facial nerve fascia of the masseter ACTION: Dilates orifi ce by pulling the lips down INSERTION: Orbicularis oris at the corners of and out mouth INNERVATION: Buccal branch of VII facial nerve MUSCLE: DEPRESSOR ANGULI ORIS ACTION: Retracts lips at the corners ORIGIN: Lateral margins of the mandible on the oblique line MUSCLE: BUCCINATOR INSERTION: Orbicularis oris & upper lip corner ORIGIN: Pterygomandibular ligament INNERVATION: Mandibular branch of the VII INSERTION: Orbicularis oris at corners of mouth facial nerve INNERVATION: Buccal branch of VII facial nerve ACTION: Depresses corners of mouth and ACTION: Moves food onto the grinding surfaces helps compress the upper lip against lower lip of the molars; constricts oropharynx MUSCLE: MENTALIS MUSCLE: LEVATOR LABII SUPERIORIS ORIGIN: Region of the incisive fossa of ORIGIN: Infraorbital margin of the maxilla mandible INSERTION: Mid-lateral region of the upper lip INSERTION: Skin of the chin below INNERVATION: Buccal branches VII facial nerve INNERVATION: Mandibular marginal branch of ACTION: Elevates the upper lip the VII facial nerve ACTION: Elevates and wrinkles chin and pulls MUSCLE: ZYGOMATIC MINOR the lower lip out ORIGIN: Facial surface of the zygomatic bone INSERTION: Mid-lateral region of upper lip MUSCLE: CORRUGATOR INNERVATION: Buccal branches VII facial nerve ORIGIN: Superciliary arch of the frontal bone, ACTION: Elevates the upper lip running in a superolateral direction INSERTION: Skin above the medial arch of the MUSCLE: LEVATOR ANGULI ORIS eyebrows ORIGIN: Canine fossa of maxilla INNERVATION: Temporal branches of CN VII INSERTION: Corners of upper and lower lips facial nerve INNERVATION: Superior buccal branches of VII ACTION: Pulls the eyebrows downward and facial nerve inward, thereby wrinkling the skin on the ACTION: Draws corner of mouth up & medially forehead between the eyes

MUSCLE: PLATYSMA masseter ORIGIN: Fascia overlaying pectoralis major and deltoid epicranius frontalis INSERTION: Corner of the mouth, region below symphysis mente, lower margin of mandible, and skin near masseter INNERVATION: Cervical branch of the VII facial nerve ACTION: Depresses the mandible MUSCLE: ORBICULARIS OCULI orbicularis ORIGIN: Nasal process of the frontal bone, oculi frontal process of the maxilla, and palpebral procreus ligament INSERTION: Lateral palpebral raphe INNERVATION: Temporal and zygomatic branches of CN VII facial nerve ACTION: Closes the eyelids, draws tear from lacrimal glands into the eyes MUSCLE: EPICRANIUS FRONTALIS zygomaticus ORIGIN: Epicranial aponeuroses INSERTION: Skin of the forehead near the eyebrows orbicularis oris INNERVATION: VII facial nerve buccinator ACTION: Raises the eyebrows and causes the skin on the forehead to wrinkle horizontally MUSCLE: INCISIVUS LABII INFERIOR risorius ORIGIN: Mandible in the region of the lateral incisor teeth INSERTION: Orbicularis oris at angle of mouth INNERVATION: VII facial nerve platysma ACTION: Pulls the corner of the mouth inward and upward MUSCLE: INCISIVUS LABII SUPERIOR summfaarcyiaalnedxpjoruersnsalionarticle ORIGIN: Maxilla above the canine teeth INSERTION: Orbicularis oris at angle of mouth INNERVATION: VII facial nerve ACTION: Pulls the corner of the mouth inward and upward People react spontaneously with different facial electromyographic (EMG) reactions in emotion-relevant facial muscles when they are exposed to emotional facial expressions, according to studies of Dimberg et al. (2000). These reflexes are due in part to a proclivity to imitate facial cues. When people are exposed to pleased and furious facial expressions, we looked at whether they can evoke similar facial replies. Despite the fact that the individuals were unaware of the happy and angry expressions, they responded with discrete facial muscle movements that matched the happy and angry stimulus faces. The findings in their study suggest that both positive and negative emotional emotions may be elicited inadvertently, and that significant components of emotional face-to-face communication can be elicited inadvertently.

MUSCLE: PLATYSMA NASAL CAVITY ORIGIN: Fascia overlaying pectoralis major and deltoid Begins at the nose and terminates in the INSERTION: Corner of the mouth, region below region of the nasopharynx (above the velum symphysis mente, lower margin of mandible, and anterior to the posterior pharyngeal walls and skin near masseter INNERVATION: Cervical branch of the VII facial nasion soft tissue triangle nerve rhinion collumellar pilar ACTION: Depresses the mandible alar sidewall supratip nostril sill MUSCLE: ORBICULARIS OCULI tip ORIGIN: Nasal process of the frontal bone, collumellar base frontal process of the maxilla, and palpebral infra-tip lobule ligament INSERTION: Lateral palpebral raphe Nose INNERVATION: Temporal and zygomatic Root- where nasal tone articulate with branches of CN VII facial nerve the frontal bone ACTION: Closes the eyelids, draws tear from Bridge- nasal bones lacrimal glands into the eyes Dorsum- cartilage extending from the nasal bones MUSCLE: EPICRANIUS FRONTALIS Apex (tip)- part that protrudes from ORIGIN: Epicranial aponeuroses the face INSERTION: Skin of the forehead near the Base- bottom of the nose where it eyebrows joins face above upper lip (Anterior INNERVATION: VII facial nerve nares- nostrils- separated by ACTION: Raises the eyebrows and causes the columella nasi) skin on the forehead to wrinkle horizontally Epithelial tissue (outer lining) Mucous membrane MUSCLE: INCISIVUS LABII INFERIOR Septal cartilage- serves as dorsum ORIGIN: Mandible in the region of the lateral and completes the nasal septum incisor teeth (posterior attachment bony nasal INSERTION: Orbicularis oris at angle of mouth septum) INNERVATION: VII facial nerve Lower nasal cartilages which form the ACTION: Pulls the corner of the mouth inward sides of the nose, Which articulates and upward with the septal cartilages and nasal bones MUSCLE: INCISIVUS LABII SUPERIOR Major and minor alar cartilage- assists ORIGIN: Maxilla above the canine teeth in completing the framework by INSERTION: Orbicularis oris at angle of mouth assisting in the formation of nares or INNERVATION: VII facial nerve nose. ACTION: Pulls the corner of the mouth inward Alar ridge or brim- the outer portion of and upward the nares Alar base- where the nares or nose NOwhTEatTOto RrEeMmEemMbBeErR: articulates with the upper lip and sides of the face or cheeks Platysma - most superficial in the neck innervated by cranial nerve 5. When the neck is tensed, platysma is being used

MmUSuCscLlEeSs OofF TthHeE NnoOseSE Nasal Cavity MUSCLE: ANTERIOR NASAL DILATOR Separated by the nasal septum ORIGIN: Lower edge of lateral nasal cartilage INSERTION: Tissue of the skin covers nasal alae Vestibule INNERVATION: Facial nerve (CN VII) ACTION: Dilates the nostrils open space immediately inside of MUSCLE: DEPRESSOR ALAE NASI the interior nares or nose ORIGIN: Incisive fossa of the maxilla INSERTION: Lower region of the cartilaginous Along lateral walls of the chamber nasal septum and adjacent alae of the nose INNERVATION: Facial nerve (CN VII) superior, middle, and inferior nasal ACTION: Depresses the alae of the nose which constricts the nostrils conchae or turbinates MUSCLE: LEVATOR LABII SUPERIOR ALAEQUE NASI The superior and medial concha is ORIGIN: Frontal process and infraorbital margin of the maxilla from the ethmoid bone INSERTION: Lateral cartilages of the nose and the orbicularis oris The inferior concha is from the INNERVATION: Facial nerve (CN VII) ACTION: Dilates the nostrils independent bone MUSCLE: NASALIS Longitudinal channels formed by the ORIGIN: Superior and lateral to the incisive fossa of the maxilla concha nasal meatuses INSERTION: An aponeurosis of the procerus muscle as well as an aponeurosis of the 3 conchae = 3 meatuses in nasalis from the opposite side INNERVATION: Facial nerve (CN VII) each chamber ACTION: Depresses the cartilages of the nose, which narrows down the nostrils Lateral walls of the nasal cavity also MUSCLE: POSTERIOR NASAL DILATOR contain the opening through which ORIGIN: Nasal aperture of the maxilla and adjacent sesamoid cartilages the paranasal sinuses drain into the INSERTION: The skin of the inferior and posterior alar cartilages nasal cavity INNERVATION: Facial nerve (CN VII) ACTION: Dilates the nostrils Ceiling of nasal cavity MUSCLE: PROCERUS cribriform plate of ethmoid ORIGIN: Lower nasal bones and upper lateral nasal cartilages perforated for the cranial nerve INSERTION: Skin off the lower forehead between the eyebrows (olfactory) to pass into the nasal INNERVATION: Facial nerve (CN VII) ACTION: The process the media angle of the cavity eyebrow and wrinkles the skin over the bridge of the nose Posterior limit of nasal cavity opens into the nasopharynx Nasal cavity communicates with the nasopharynx via posterior nares or choanae Interior of nasal cavity Covered by mucous membrane. It is ciliated and has a mucus blanket which traps organisms and contaminants. The cilia continually sweeps mucus and tract invaders into the nasopharynx then throat then stomach. openings of ethmoid bulla frontal, maxillary and anterior opening of ethmoidal sinuses sphenoid sinus opening of nasolacrimal duct opening of eustachian tube

PHARYNGEAL CAVITY Stylopharyngeus Elevates the pharynx and pulls the lateral From the base of the skull to the walls even more laterally esophagus Widdens the pharyngeal lumen Composition is similar to the velum: This muscle along with the basement skeleton is Pharyngeal Palatopharyngeus elevates the pharynx aponeurosis and the larynx which is necessary for Intermediate layer of muscle tissue swallowing Superficial layer of mucous membrane Salpingopharyngeus Pharyngeal aponeurosis Assists in the narrowing of the Funnel shaped sheet of connective tissue pharyngeal lumen (12cm in length, 4cm widest, 2cm at its When it contracts it pulls the lateral walls deepest, 2.5 narrowest) of larynx upward and inward and Anterior and posterior pharyngeal walls decreasing the width of the pharynx touch each other and do not separate until food or drink passes on the way to Mucous Membrane the esophagus Superficial Layer, continues with mucous membrane of oral cavity, larynx, and Pharyngeal muscles esophagus Act as a sphincter Nasopharynx- columnar ciliated Moves to the midline and reduces the epithelium diameter Oropharynx and laryngopharynx- Important of swallowing and resonance stratified squamous cells Superior pharyngeal constrictor PHARYNGEAL REGIONS Most complex but the weakest Nasopharynx Buccopharyngeus Glossopharyngeus opening of the pharynx to the nasal Mylopharyngeus cavity Ptery Pharyngeus Choanae to Posterior Pharyngeal Wall Torus Tobarius- ridge in the lateral walls Medial pharyngeal constrictor of the nasopharynx (Salpingopalatine- Ceratopharyngeus anterior, Salpingopharyngeus- posterior) Chondro Pharyngeus Pharyngeal ostium of the Eustachian tube- under curved part of the Torus Inferior pharyngeal constrictors Tobarius Cricopharyngeus Adenoids- along the Posterior Pharyngeal Thyropharyngeus (upper esophageal Wall, superior to the velum sphincter) Pharyngeal bursa- groove in the mucous membrane that runs vertically at the Palatopharyngeus (Velar Deprssor) midline from the adenoids at the base of Fibers blend with fibers of the pharynx the skull Shortens the distance between the velum and the pharynx Oropharynx Causes the narrowing of the posterior opening of the pharynx to the oral cavity faucial pillars Velum to hyoid bone With the velum stabilized, the Palatopharyngeus assists the Superior Laryngopharynx constrictor in growing the lateral opening of the pharynx to the larynx pharyngeal walls medially Hyoid bone to aditus laryngis

NEURAL INNERVATION All muscles of velum (except Tensor Veli Palatini) - CN V All intrinsic and extrinsic tongue muscles (except palatoglossus)-CN XII and possibly CN XI Mandibular elevators - CN V (anterior trunk of mandibular branch) Pharyngeal constrictors - CN X Stylopharngeus - CN XII Mandibular depressors: Anterior belly of digastricus, lateral pterygoid, mylohyoid - CN V, Posterior body of digastricus - CN VII and Geniohyoid - CN XII Muscles of nose and face: Motor - CN VII and Sensory - CN V innervation of selected muscles of the articulatory / resonatory system MUSCLES OF THE ARTICULATORY / RESONATORY SYSTEM MUSCLE INNERVATION MANDIBULAR MUSCLES Trigeminal (CN V), anterior trunk of mandibular branch Elevator Muscles Trigeminal (CN V), anterior trunk of mandibular branch Trigeminal (CN V), anterior trunk of mandibular branch Masseter Medial (internal) Pyterygoid Anterior belly-trigeminal (CN V); posterior belly-facial (CN VID) Temporalis Depressor Muscles Hypoglossal (CN XIN) Digastricus Trigeminal (CN V), mandibular branch Geniohyoid Trigeminal (CN V), mylohyoid branch Lateral (exteral) pterygoid Mylohyoid TONGUE MUSCLES Hypoglossal (CN XID) Extrinsic Muscles Hypoglossal (CN XID) Vagus (CN X); possibly spinal accessory (CN XI) Genioglossus Hypoglossal (CN XID) Hyoglossus Palatoglossus Hypoglossal (CN XID) Styloglossus Hypoglossal (CN XID) Intrinsic Muscles Hypoglossal (CN XID) Inferior longitudinal Hypoglossal (CN XID) Superior longitudinal Transverse Vertical VELAR MUSCLES Vagus (CN X) Levator veli palatini Vagus (CN X): possibly spinal accessory (CN XI) Musculus uvulae Vagus (CN X): possibly spinal accessory (CN XI) Palatoglossus Vagus (CN X): possibly spinal accessory (CN XI) Palatopharyngeus Trigeminal (CN V) Tensor veli palatini PHARYNGEAL MUSCLES Vagus (CN X); possibly spinal accessory (CN XI) All pharyngeal constrict muscles Vagus (CN X); possibly spinal accessory (CN XI) Palatopharyngeus Vagus (CN X); possibly spinal accessory (CN XI) Salpingopharyngeus Glossopharyngeal (CN IX) Stylopharyngeus

PHYSIOLOGY OF RESONATION Formants group of frequencies that determine Resonation characteristics speech sounds Physical property of an object F1: Volume of the Pharyngeal Cavity Free vibration or the vibration of a system How tightly the vocal tract is without interference at a rate determined constricted by its mass, tension, and thickness F2: Length of the Oral Cavity dependent on the pharyngeal Changes are caused by the changes structures, tension, volume, mass, in position of the tongue rigidity of structures F0: Fundamental Frequency Resonant Frequency Variable Resonator Frequency at which the object vibrates Odd-number multiples of the lowest RF Forced vibration: vibrations from one object sets another object into vibration if 17cm (males) x 4 = 68cm the wavelength they have a relatively near resonant of the lowest F frequency 34000 cm/s (speed of sound) / 68 = 500 Hz lowest RF Resonator 500 Hz x 1 (500 Hz), 500 Hz x 3 (1500 Hz), Object that vibrates in response to 500 Hz x 5 (2500 Hz) (FORMANTS) another vibration Resonator will vibrate with the greatest The vocal tract can produce complex amplitude at frequencies close to the periodic sounds that consist of center frequency of the vibrating body, fundamental frequencies that range from (so meaning the resonator will only 85Hz to 180Hz, which corresponds to the vibrate if there is another source of sound frequency of the vocal fold vibration or another object that vibrates that Many harmonics decrease in intensity as causes it to vibrate as well) they increase in frequency at a rate of Acoustic - container that is filled with 12dB per octave air (ex. Guitar, human speech system) An adult produces vowel formants at Mechanical - actual object that is set 500-1500-2500 Hz into vibration (ex. tines) Sound produced has a similar fundamental frequency and harmonics How is Resonation anatomically possible? but it changes the amplitude of the The pharynx as the primary resonator of harmonics that’s why there will be sounds the vocal tract that are louder and softer The Oral and Nasal cavity as the final resonating chambers The Velum as the door/valve for the passage of sound to the nasal and oral cavities (it directs the airflow of the sound) Vocal Tract Approx. 17cm in males 14/15 cm in females 8-9cm in children

Source Filter Theory - G. Fant (1960) sOURCE Source Source: vocal folds (F0) Spectrum Filter: vocal tract (F1 and F2) Glottal Flow Pharynx Oral and Nasal Cavity FILTER Vocal Tract Area Vocal Tract Vowels are produced due to a: Function Frequency Response Change in vocal tract Constriction or dilation of the OUTPUT Output Sound Output Spectrum Pharynx Pressure Change in tongue placement Horizontal and vertical placements Vowel Formant Frequencies of the tongue Dependent on: Source Function: Glottal Sound Tongue height Sound that exists and exits at the High vowels: Low F1 Larynx Low vowels: High F1 Like the F0 Tongue advancement Resonance Curve: Vocal Fold Resonator Position of the tongue horizontally Frequency response of the vocal tract Back Vowels: Low F2 If the F0 is [X value], vocal tract Front Vowels: High F2 should be within the range of that F0 Degree of constriction Output Function: the actual sound How constricted the cavities are More constricted: Higher Resonators are Filters Frequency and Lower volume They respond to some frequencies, but not to others Articulation Resonators vibrate to resonant Accuracy, direction, and timing of the frequencies of the source that is close to movements of the vocal tract structures their resonant frequency depending on to produce speech sounds the volume and rigidity of the structure Mobile Filtering: exclusion and attenuation of Tongue (largest) certain frequencies, and the transmission Mandible and amplification of others Soft Palate/Velum Bandwidth of Resonators: pertains to the Lips range of frequencies to which th Immobile: fixed in position resonators with respond bestSimilar to Alveolar Ridge resonant frequency Hard Palate Teeth Formant Frequencies Placement of the oral structures Oral > Pharyngeal Volumes Change the vocal tract shape ➔ Volumes of the Pharyngeal and oral spaces ➔ The formant frequencies of the cavities changed ➔ Different vowel

UNIT FIVE: RESONATION AND ARTICULATION ACTIVITY The articulatory system is an extremely important element in our communication system. Articulation for speech is the process of bringing two or more moveable speech structures together to form the sounds of speech.

UNIT FIVE: RESONATION AND ARTICULATION ACTIVITY The articulatory system is an extremely important element in our communication system. Articulation for speech is the process of bringing two or more moveable speech structures together to form the sounds of speech. The velum, also known as the soft palate, serves as the cover for the nasal cavity. The velopharyngeal mechanism separates the oral and nasal canals by creating a tight barrier between the velum and pharyngeal walls for numerous functions, including communication. With that said, if the velum is not moving an issue regarding velopharyngeal insufficiency (VPI), velopharyngeal incompetence (VPI) and velopharyngeal mislearning, all of which are caused by abnormality, poor movement and poor closure, respectively. A VELOPHjAouRrYnaNlGaErAticLlEesXPIRENCE The velopharynx is a dynamic anatomic structure that allows you to breathe, eat, and speak normally. Although a dysfunctional velopharynx affects the separation of the nasal and oral canals during swallowing and certain oral consonant articulations, the upper airway is only affected iatrogenically as a result of velopharyngeal dysfunction therapies (VPD). Marsh (2004) mentioned in his article that the objective of differential management, in the study, based on differential diagnosis is to optimize the function of the velopharynx for speech tasks while minimizing the morbidity of the intervention on the upper airway. His personal experience, in the context of an interdisciplinary cleft team, with such an approach over the past 20 years validates the assumption that differential management of VPD based on differential diagnosis can achieve this goal.

UNIT FIVE: RESONATION AND ARTICULATION ACTIVITY The articulatory system is an extremely important element in our communication system. Articulation for speech is the process of bringing two or more moveable speech structures together to form the sounds of speech. ANSWER THE FOLLOWING QUESTIONS BASED ON THE FIGURE ABOVE 1.Provide six (6) phonemes that can be produced using structure F. The mouth and lip motions are controlled by the orbicularis oris muscle, which means that the labialphonemes such as /b/, /m/, /o/, /p/, and /w/. 2.What issues will a person experience if structure L is damaged? The zygomaticus major muscle is a facial muscle that pulls the mouth angles posteriorly and superiorly, meaning that it governs facial expression, chewing and speaking. If impacted with trauma or is overused, such facial muscles lose their nerve supply, or become denervated meaning that the face may lose symmetry and movement. 3.Provide at least four (4) muscles involved in the production of /u/ (as in oolong) sound Orbicularis oris controls the motions of the mouth and lips. Mentalis allows the lower lip to pout by support from the chin. Depressor labii inferior pulls down the lower lips. By contracting, levator labii superioris helps other buccolabial muscles to elevate and invert the upper lip.

UNIT FIVE: RESONATION AND ARTICULATION ACTIVITY The articulatory system is an extremely important element in our communication system. Articulation for speech is the process of bringing two or more moveable speech structures together to form the sounds of speech. journal articles THE SOURCE–FILTER THEORY OF SPEECH The source-filter theory describes speech creation as a two-stage process: (a) Air passage from the lungs triggers tissue vibrations in the vocal folds (two small muscle folds in the larynx) and generates the \"source\" sound. To generate noisy sound sources, turbulent airflows are also created in the glottis or in the vocal tract. (b) The vocal tract \"filter\" shapes the spectral patterns of these source sounds, amplifying frequency components corresponding to vocal tract resonances while decreasing frequency components not relating to vocal tract resonances. The voice pitch is primarily defined by the source sound, whereas the timbre is defined by the filter. Tokuda (2021) discussed in his research how the frequency components corresponding to the vocal tract resonances are enhanced by the filtering process, while the other frequency components are reduced. The voice pitch (i.e., fundamental frequency) is primarily defined by the source sound, whereas the timbre is defined by the filter. The source-filter hypothesis accurately describes natural speech production and has been applied to speech analysis, synthesis, and processing with great effectiveness. Separate management of the source (phonation) and filter (articulation) is desirable for acoustic communications, particularly for human language, which necessitates the production of several phonemes via a variable vocal tract design. In order to characterize the produced speech sounds, articulatory phonetics focuses on the positions of the vocal organs. Furthermore, Tokuda noted that the source–filter theory is predicated on the notion that the source and filter are separate entities. The source and the filter can interact under specific circumstances. The source sound is impacted by the vocal tract geometry as well as the vocal tract's acoustic feedback. Voice instabilities such as rapid pitch jumps, subharmonics, resonance, quenching, and chaos are all caused by this type of source–filter interaction.

UNIT FIVE E-PORTFOLIO reflection RESONANCE AND ARTICULATION This section of the e-portfolio have discussed the systems of articulation and resonation, with their respective parts like the articulators, bones of the face and cranial skeleton, dentition, cavities of the vocal tract, the numerous muscles of the face and mouth, and an important figure, the source-filter theory. If I must say, I was really overwhelmed with the knowledge and lessons for this unit because it had a lot of ideas and subjects that are significant to understanding the whole lesson itself. As a speech-language pathology student, I am impressed by the incredible flexibility of motor planning demonstrated in this presentation, because this is a feature that can be used in treatment in the future. We frequently move one articulator to make contact with another during speech, thereby situating a movable articulator in proximity to an immobile articulator. The tongue, mandible, teeth, hard palate, and velum are the most important mobile and static articulators, while all surfaces and cavities within the articulatory/resonatory system contribute to speech production. Moreover, I've realized how I am part of the percentage of those with Class 3 malocclusion, which I've only knew as an underbite. This occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth. Funny thing is, I've been wearing braces since the 5th grade (until now), so most likely, it's the longest relationship I've had. Kidding aside, I didn't notice how it affected my speech back then because maybe I was unaware, pero I definitely had an ugly side profile back then because of my lower teeth. Going back to the unit discussion, the formant frequencies help me with my other courses, especially 1041 as it discusses the mechanism how the tongue height, position of tongue advancement and its degree of constriction are all significant for vowel formant frequencies. To wrap it up, the articulatory and resonatory systems are significant with how we produce the words as they shape them.

ANATOMY AND PHYSIOLOGY OF SWALLOWING 6

FOOD AND DRINK CONSISTENCIES LIQUIDISED (moderately thick) - LEVEL 3 Can be drunk from a cup DRINK CONSISTENCIES Moderate effort is required to suck aka Liquids which flows through a standard bore or wide bore May sometimes flow too fast that straw viscosity modification needed Cannot be piped, layered or molded on a plate because it will not retain its shape. LEVELS OF LIQUIDS Cannot be eaten with a fork because it THIN - LEVEL 0 drips slowly in Can be eaten with a spoon Flows like water No oral processing or chewing required - Fast flow can be swallowed directly Can drink through any type of Honey thick consistency teat/nipple, cup, or straw as appropriate Smooth texture with no ‘bits’ (lumps, for age and skills fibers, bits of shell or skin, husk, particles of gristle or bone) SLIGHTLY THICK - LEVEL 1 Thicker than water PUREED (extremely thick) - LEVEL 4 Requires a little more effort to drink thank ex . regular mashed potato thin liquids Usually eaten with a spoon (a fork is Flows through a straw, syringe, possible) teat/nipple Cannot be drunk from a cup because it Similar to the thickness of most does not flow easily commercially available ‘Anti-regulation’ can not be sucked through a straw (AR) infant formulas Does not require chewing Can be piped, layered or molded MILDLY THICK - LEVEL 2 because it retains shape, but should not Flows off a spoon require chewing if presented in this form Sippable, pours quickly from a spoon, but Shows some very slow movement under slower than thin drinks. gravity but cannot be poured Mild effort is required to drink this Falls of spoon when tilted and continues thickness through standard bore straw to hold shape on a plate (standard bore straw = 0.209 inches or No lumps 5.3 mm diameter) Not sticky Liquid must not separate from solid COtNesStiInSgTEtNhCe YcoFnLsOisWtenTcyEST

FOOD CONSISTENCIES LEVEL 7 REGULAR aka solids that usually needs mastication Normal, everyday foods of various Exertion of tongue to propel the bolus textures that are developmentally and age appropriate MINCED AND MOIST - LEVEL 5 Any method may be used to eat these Can be eaten with a fork or spoon foods Could be eaten with chopsticks in some Foods may be hard and crunchy or cases, if the individual has very good naturally soft hand control. Sample size is not restricted at Level 7, Can be scooped and shaped (e.g. into a therefore, foods may be of a range of size ball shape) on a plate Includes hard, tough, chewy, fibrous, Soft and moist with no separate thin stringy, dry, crispy, crunchy, or crumbly liquid bits. Small lumps visible within the food Includes food that contains pips, seeds, Lumps are easy to squash with tongue pith inside skin, husks or bones Holds its shape in the fork/spoon Includes ‘dual consistency’ or ‘mixed consistency’ food and liquids SOFT AND BITE-SIZED - LEVEL 6 Can be eaten with a fork, spoon, or ABBwRhEaVtIAtToIOrNeSmTeOmbNeOrTE chopsticks Can be mashed/broken down with Numbers occur at the end of the abbreviations pressure from a fork, spoon, or chopsticks to ensure that they are not confused for ‘number A knife is not required to cut this food, but of meals or drinks ordered’. Abbreviations retain may be used to help a load a fork or the core of the IDDSI label (e.g. SB6 spoon acknowledges both ‘Soft’ & ‘Bite-sized’.) Soft, tender and moist throughout but with no separate thin liquid Chewing is required before swallowing ‘Bite-sized’ pieces as appropriate for size and oral procession skills EASY TO CHEW - LEVEL 7 Normal, everyday foods of soft/tender textures that are developmentally and age appropriate Any method ay be used to eat these food Sample size is not restricted at Level 7, therefore, food may be of a range of sizes Does not include: hard, tough, chewy, fibrous, stringy, crunchy, or crumbly bits, pips, seeds, fibrous parts of fruit, husks or bones May include ‘dual consistency’ or ‘mixed consistency’ food and liquids if also safe for Level 0, and at clinician discretion. If unsafe for Level 0 thin, liquid portion can be thickened to clinician’s recommended thickness level

MASTICATION AND DEGLUTITION Physiological Variable in Infants vs. Adults Mastication 1. MOUTH part of digestion as it breaks down the Infants - Tongues fill the mouth. Cheeks food into smaller pieces have sucking pads. Small mandible proportionate to the cranium. Structures Adults - The mouth is large and the Depression causes muscles to be tongue rests on the floor of the mouth. stretched. The contraction enables the mandible to elevate and go back to its 2. PHARYNX original position (closed) Infants - Gentle curve from the When you depress your mandible, the nasopharynx to the hypopharynx, hence muscle contracts. no definite or distinct oropharynx. Pharynx Muscles that elevate are attached found at level of 3rd cervical vertebrae. differently to the mandible Adults - Gentle curve becomes a 90 degree angle between the nasopharynx Oral Preparatory Phase and oropharynx. Pharynx found at level of Where mastication occurs since this is 6th cervical vertebrae. where the breakdown of the bolus happens 3. LARYNX Catapulting motion of the bolus and the Infants - Located at the 3rd and 4th elevation of the tongue cervical vertebrae Vocal cord length: 6mm to 8mm Esophageal Phase Glottis width at rest: 3mm Respiration stops before swallowing Maximum glottis: 6mm Inhalation->swallow->expiration Narrow vertical epiglottis (natural) Adults - Descends to 6th cervical Maintains subgottal pressure to avoid (childhood) and rest at 7th cervical food going to respiratory tract. The left vertebrae (puberty). blous won’t overflow to laryngeal spaces V` ocal cord length Males: 17mm to 23 mm, females: 12.5 mm to 17 mm. RELATIONSHIP OF RESPIRATION & SWALLOWING Glottis width at rest: males 8 mm females: 6mm. TIME OF Immediately During the Maximum glottis: males 19 mm, EVENTS before the swallow females 13 mm. Flat, wide epiglottis. swallow immediately 4. TRACHEA and after Infants - Diameter of pencil (-0.8 cm) Adults - Diameter of 2.5 cm the swallow 5. ESOPHAGUS HEALTHY Small Small exhalation Infants CYCLE inhalation apnoea 5mm diameter, 11 cm long Adults (swallow) 2 cm diameter, 23 cm to 25 cm long immediate exhalation 6.VOLUME PER SWALLOW Infants - 0.2 ml (+- 0.11ml) DYSPHAGIC Stroke. Variable Apnoea (swallow) Adults - 20 ml to 25 ml per mouthful. SWALLOW respiratory Variable pattern Swallows per day CYCLE respiratory Infant - 600 to 1000 pattern Adults - 600+ post-swallow

oral preparation stage muscles MUSCLES OF ORAL PREPARATION STAGE MUSCLE FUNCTION INNERVATION FACIAL MUSCLES Maintains oral seal Facial Nerve Orbicularis oris Elevates lower lip Facial Nerve Mentalis Flattens cheeks Facial Nerve Buccinator Flattens cheeks Facial Nerve Risorius MANDIBULAR MUSCLES Elevates mandible Trigeminal Masseter Elevated mandible, retracts and protrudes Trigeminal Temporalis Elevates mandible, moves mandible trigeminal Trigeminal Medial pterygoid laterally; grinds mandible MANDIBULAR MUSCLES Elevates floor of mouth Trigeminal Mylohyoid Elevated hyoid; depresses mandible Hypoglossal Geniohyoid Elevates hyoid; depresses mandible Trigeminal; Facial Digastric TONGUE MUSCLES Moves tongue body; cups tongue Hypoglossal Genioglossus Elevates posterior tongue Hypoglossal Styloglossus Elevates posterior tongue IX, X and X1 Palatoglossus Depresses tip; deviates tip Hypoglossal Inferior longitudinal Elevates tip; deviates tip Hypoglossal Superior longitudinal Ups and grooves tongue Hypoglossal Vertical SOFT PALATE MUSCLES Depresses velum IX, X, and XI Palatoglossus Depresses velum X and XI Palatopharyngeus SWALLOWING ANjoDurCnaHlAaNrtGicElSe IN STRUCTURES Swallowing is a complicated process that necessitates the sensorimotor integration and coordination of a variety of anatomic components, muscles, nerves, and the brain. Malandraki and Robbins (2013) mentioned in their journal that as humans become older, all of these functioning components undergo healthy chronologically associated anatomical and physiological changes. The oral components of normal deglutition are detailed, followed by a complete overview of all known motor, taste, sensory, and neurological abnormalities impacting the oral swallow in healthy elderly. Although most elders' alterations appear to be minor and develop slowly and insidiously, they may indicate a decline in swallowing functional reserve capacity and endurance, making them more susceptible to dysphagia and airway invasion as a result of illness and environmental factors. Understanding these alterations, as well as the underlying peripheral and central processes that cause them, is critical for discovering treatments and even prevention for some diseases.