Last edited: 9/12/2021

1. DEGLUTITION (SWALLOWING)
Gastrointestinal | Deglutition (Swallowing) Medical Editor: Uta Hüning

Salivary glands
OUTLINE
o Intrinsic (produce 10% of saliva)
I) DEFINITION o Extrinsic (produce 90% of saliva)
II) 1. ORAL PHASE Muscles + teeth broke food down into small particles
III) 2. PHARYNGEAL PHASE Saliva lubricates particles
IV) 3. ESOPHAGEAL PHASE o Moisten, lubricate, soften it
V) SUMMARY o Mucins, digestive enzymes mix with it
VI) APPENDIX
VII) REVIEW QUESTIONS
Mastication + Salivation:
o Increase surface area for chemical digestion
(salivary amylase, lingual lipase)
I) DEFINITION o Decreases abrasion of GI lining (especially pharynx
and oesophagus)
Swallowing = bringing food from the oral cavity to the  Why important? Imagine swallowing a whole
stomach potato chip, the scratchy surface would hurt and
Path of food: oral cavity → pharynx → esophagus damage the mucosa
→ stomach → duodenum: absorption
3 Phases (3) Role of the tongue
o Oral phase Tongue takes a special shape and position
o Pharyngeal phase o Intrinsic muscles:
o Esophageal phase  Form central trough around food bolus
 By: superior longitudinal, inferior longitudinal,
II) 1. ORAL PHASE vertical, transverse mm.
o Extrinsic muscles:
(1) Receiving food
 Elevate tongue so that tip touches palate
Bringing food into the oral cavity
For eating, we need to open the mouth  By: styloglossus m, genioglossus m, mylohyoid m.

Mandibular depressors:
o Lateral pterygoid m. (CN V3 - mandibular nerve)
o Digastric m. (anterior belly) (CN V3)
o Mylohyoid m. (CN V3)
o Geniohyoid (cervical plexus, mainly C1)
We depress mandible

Mandibular elevators:
o Masseter m. (most powerful) (CN V3)
o Temporalis m. (CN V3)
o Medial pterygoid m. (CN V3)
(2) Turning food into bolus Figure 1: Tongue form a downward slope and central through
so that food slides back into pharynx
Mechanical digestion = breaking food into small pieces
(not breaking any chemical bonds) III) 2. PHARYNGEAL PHASE
Muscles of mastication (most important ones only):
Once bolus touches palatoglossal arch → oral phase
o Lateral pterygoid m.
ends, pharyngeal phase begins!
o Medial pterygoid m.
In back of oral cavity we find:
o Masseter m.
o Palatopharyngeal arch
o Temporalis m.
o Palatoglossal arch
Teeth o Tonsillar fossa
o Incisors: cutting food
Bolus touches these areas
o Canines: tearing food
o Molars: grinding, crushing food
Once the muscles contract, pressure receptors detect it
(in oral mucosa, gingiva, tongue,…)

Deglutition (SWALLOWING) GASTROINTESTINAL PHYSIOLOGY: Note #1. 1 of 4

 Figure 2: The back of the oral cavity is highly innervated by
Figure 4: Bolus is diverted from larynx
sensory nerve ending
From oral cavity bolus could continue to: (3) How to ensure that pharynx is ready for the bolus?
o Nasopharynx Arches contract:
o Esophagus  Palatoglossus mm.
o Larynx  Palatopharyngeus mm.
(1) How do we prevent the bolus from going to the
nasopharynx?
Bolus stimulated sensory afferent fibers of CN IX
Elevate pharynx, elevate larynx → bring pharynx closer
to bolus
o Contracts uvula → elevates uvula
o Outer longitudinal layer of muscles contracts
 Stylopharyngeus m. (CN IX, this is the only motor
o Contracts muscles of soft palate (elevator veli
component of this cranial nerve)
palatini m.) → elevates soft palate → increases
 Salpingopharyngeus m. (CN X)
distance btw. bolus and soft palate
 Palatopharngeus m. (CN X)
o Contracts muscles supporting soft palate (tensor Squeeze pharynx (to push bolus downwards)
veli palatini m.) → tenses soft palate → supports o Inner circular layer of muscles contracts
elevation of soft palate  Superior, middle, inferior pharyngeal constrictors
 Do pharyngeal peristalsis to push bolus down
Elevate larynx + move anteriorly
o Suprahyoid muscles
 Digastric m., ant. + post. Belly
 Stylohyoid m., geniohyoid m., mylohyoid m.
o Contraction → pull hyoid bone up → pulls larynx up
and anteriorly
Bolus moves into oesophagus
o At the lowest part of the inferior pharyngeal constrictor
is: cricopharyngeus m. acts as UES (upper
oesophageal sphincter) (CN X)
o Pharyngeal peristalsis → descending axons relax

Figure 3: Bolus is diverted from nasopharynx

(2) How do we prevent the bolus from going to larynx?
When we swallow 2 things happen:
Approximate/adducts vocal cords
o True vocal cords: important for phonation
(vibrate → create sound)
o Contraction of:
 Lateral cricoarytenoid m.
 Transverse / oblique arytenoid mm.

Fun fact:
Deglutition apnea = while swallowing we do not
breath, holding our breath automatically

Epiglottis
o Retroversion of epiglottis: Figure 5: Bolus is directed into esophagus
 When bolus touches epiglottis, it bends over the
glottis to protect it (close it)
o Contraction of:
 Aryepiglottic m.
2 of 4 GASTROINTESTINAL PHYSIOLOGY: Note #1. Deglutition (SWALLOWING)
 IV) 3. ESOPHAGEAL PHASE V) SUMMARY
Begins when bolus moves past UES (1) Oral phase
Esophagus is very muscular
Peristalsis started in pharynx, continues in esophagus Boundaries of oral cavity
o Anterior: oral vestibule (space btw. teeth and lips)
o Posterior: palatoglossal arch
Mastication:
o Lateral pterygoid, medial pterygoid, masseter,
temporalis m.
Problems with relaxation of LES: o Innervated by CN V3 (mandibular br. of trigeminal n.)
o GERD (gastro-esophageal reflux disease) Salivation:
(esophagus passes through diaphragm) o Chemical digestion
o Hiatal hernia (because esophagus passes through o Soften food, form bolus
diaphragm) Central trough and downward slope of tongue:
o Intrinsic + extrinsic mm. of tongue
o Innervated by CN XII (hypoglossal n.)
(2) Pharyngeal phase
Prevent bolus from going into nasopharynx
o Uvula contract
o Soft palate is elevated
Prevent bolus from going into larynx
o Approximate vocal cords → glottis shrinks
o Epiglottis covers glottis
Ensure bolus enters pharynx
o Tighten arches
o Elevate pharynx
o Squeeze pharynx
o Elevate larynx and move anteriorly
Pharyngeal peristalsis

(3) Esophageal phase

Figure 6: Bolus passes esophagus by peristalsis and arrives in Continuation of pharyngeal peristalsis
stomach
(1) Peristalsis
Primary peristalsis
(i) Primary peristalsis o Wave-like continuation of pharyngeal peristalsis
Continuation of pharyngeal peristalsis Secondary peristalsis
o Onset of new peristalsis due to activation of stretch
receptors in esophageal wall to ensure bolus moves
down
o Contract above bolus, relax below
(ii) Secondary peristalsis
When bolus is stuck

o Above bolus:
 Stimulates circular layer of muscles
 Inhibits longitudinal layer of muscles
o Below bolus, descending axons:
 Stimulate longitudinal layer of muscles
 Inhibit circular layers of muscles

Figure 7: Primary and secondary peristalsis in esophagus

Deglutition (SWALLOWING) GASTROINTESTINAL PHYSIOLOGY: Note #1. 3 of 4

 VI) APPENDIX

Figure 8: Overview - phases and mechanism of deglutition (swallowing)

5) During the pharyngeal phase the bolus is pushed

VII) REVIEW QUESTIONS
downwards by:
1) Mastication and salivation a) Peristalsis from outer longitudinal layer of muscles
a) Increase surface area of bolus and decrease b) Peristalsis from inner circular layer of muscles
abrasion of GI lining c) Elevation of pharynx
b) Decrease surface area of bolus and increase d) Elevation of larynx
abrasion of GI lining 6) Which muscle constitutes the UES, how is it
c) Increase surface area of bolus and increase innervated?
abrasion of GI lining a) Palatopharyngeus, by CN IX
d) Decrease surface area of bolus and decrease b) Aryepiglottic m., by CN IX
abrasion of GI lining c) Cricopharyngeus m., by CN X
2) A measure that prevents the bolus from traveling d) Salpingopharyngeus m., by CN X
into the larynx is: 7) Wave-like peristalsis that continues from pharynx to
a) Constriction of uvula esophagus until the stomach is called:
b) Tightening of soft palate a) Primary peristalsis
c) Retroversion of epiglottis b) Secondary peristalsis
d) Elevation of pharynx c) Tertiary peristalsis
3) Deglutition apnea is: d) Wave-peristalsis
a) An acute onset of breathlessness that can occur
when swallowing CHECK YOUR ANSWERS
b) A pathological condition that occurs mostly at night
c) A physiological reaction
d) An early symptom of pneumonia
4) For contraction of the uvula is responsible:
a) CN V3
b) CN IX
c) CN X
d) CN XII

4 of 4 GASTROINTESTINAL PHYSIOLOGY: Note #1. Deglutition (SWALLOWING)