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By Christopher L. B. Lavelle

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The second and third phases of swallowing demonstrate involuntary reflexive central nervous system control, which may be based on a swallowing centre. Initiation of swallowing Although reference is often made to the 'swallowing centre', this is probably an oversimplification. It is likely that modulation of the processes of deglutition results from impulse activity in cranial nerves other than those intermittently associated with swallowing itself. For instance, salivatory preparation of the bolus cannot occur in the absence of cholinergic activity mediated through the peripheral and autonomie nervous systems.

Mechanical dysfunction of deglutition is usually the result of oral and/or pharyngeal structures being surgically removed or altered, thereby impairing the displacement of food to the pharynx. Even though some patients have adequate sensory and motor components for oral and pharyngeal feeding postoperatively, most have significant dysphagia. Additionally, the majority have adequate cortical skills needed for the rehabilitation of feeding. disorders (1) Syringomyelia. (2) Cerebral palsy. Mechanical disorders Patients with mechanical disorders of deglutition evidence difficulty secondary to the loss of sensory guidance of the structures necessary to complete a normal swallow.

The levator and tensor veli palatini muscles elevate the soft palate, with additional shortening and dorsal thickening until approximation against the posterior pharyngeal muscle prevents nasopharyngeal régurgitation. The middle and inferior pharyngeal constrictor muscles narrow the hypopharynx and contribute to the peristaltic movements involving the posterior pharyngeal wall, generally between Passavant's ridge and the cricopharyngeal sphincter. The dorsal and downward tilting of the epiglottis, resulting from muscular elevation of the larynx, contraction of the floor of the mouth, along with elevation and posterior movement of the hyoid bone.

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