What is the pathophysiology of dysphagia in oral-phase disorders?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Pocketing of food in the mouth, circumoral leakage, and early pharyngeal spill can occur with weakness and poor coordination of the lips, cheeks, and tongue. Weak posterior tongue can lead to abnormal tongue thrusting.

Aspiration of food or drink, especially during inhalation, can occur before pharyngeal swallowing due to premature pharyngeal spillage.

Changes in mental status with cognitive deficits also may affect the initiation of swallowing, increasing the tendency to pocket food in the lateral sulci and leading to possible aspiration.

Logemann's Manual for the Videofluorographic Study of Swallowing cites the following oral-phase swallowing symptoms and disorders [11] :

  • Inability to hold food in the mouth anteriorly due to reduced lip closure

  • Inability to form a bolus or residue on the floor of the mouth due to reduced range of tongue motion or coordination

  • Inability to hold a bolus due to reduced tongue shaping and coordination

  • Inability to align teeth due to reduced mandibular movement

  • Entry of food material into the anterior sulcus or the presence of residue in the anterior sulcus due to reduced labial tension or tone

  • Entry of food material into the lateral sulcus or the presence of residue in the lateral sulcus due to reduced buccal tension or tone

  • Abnormal hold position or dropping of material to the floor of the mouth due to tongue thrust or reduced tongue control

  • Delayed oral onset of swallow due to apraxia of swallow or reduced oral sensation

  • Searching motion or inability to organize tongue movements due to apraxia of swallow

  • Forward tongue movement to start the swallow due to tongue thrust

  • Residue of food on the tongue due to reduced tongue range of movement or strength

  • Disturbed lingual contraction (peristalsis) due to lingual discoordination

  • Incomplete tongue-to-palate contact due to reduced tongue elevation

  • Inability to mash material due to reduced tongue elevation

  • Adherence of food to hard palate due to reduced tongue elevation or reduced lingual strength

  • Reduced anterior-posterior lingual action due to reduced lingual coordination

  • Repetitive lingual rolling in Parkinson disease [12]

  • Uncontrolled bolus or premature loss of liquid or pudding consistency into the pharynx due to reduced tongue control or linguavelar seal

  • Piecemeal deglutition

  • Delayed oral transit time


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