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frontalis: the forehead corrugator: the brow nasalis: the nose obicularis oculi: around the eye levator labii: raises the upper lip masseter: closes the jaw Obicularis oris: purses the lips risoris: draws the lips in a smile buccinator: pulls the lips wide and tight depressor labii: lowers the lower lips depressor anguli oris: lowers the bottom corner of the lips l evator anguli oris (not shown): raises the upper corner of the lips pterigoid (not shown): pulls jaw back or shut mentalis: pulls chin down
Facial muscles around the mouth. NOTE: muscle contraction follow direction of fibers A- m. levator labii superioris , B – m. zygomaticus minor, C - m. zygomaticus major , D - m. risorius , E - m. depressor anguli oris , F - m. labii inferioris , G - m. orbicularis oris )
The tongue is restricted in its movements by a strand of mucosa (lingual frenum) that attaches the anterior third of the tongue to the floor of the mouth and the lingual gingival mucosa. Persons with this condition are commonly called "tongue-tied." Treatment is surgical.
Oral Phase of Swallowing Food is held within the mouth A bolus is formed in the central portion of the tongue At same time, the base of the tongue and the soft palate close the oral cavity to prevent food spilling into the open larynx and trachea. Tongue pushes bolus posteriorly toward the pharynx with an anterior-to-posterior tongue elevation. As the bolus enters the pharynx the actual swallow or pharyngeal reflex is triggered. B
Pharyngeal Phase This phase is a reflex action. The bolus passes through the pharynx quickly and then enters the esophagus. This takes place in less than a second. The initiation of this process starts when the bolus passes the anterior faucial arch and reaches the posterior pharyngeal wall. Elevation of the soft palate prevents material from entering the nasal cavity. This stage is followed by the pharyngeal constrictor muscles pushing the bolus further into the pharynx, toward the cricopharyngeal sphincter. The larynx prevents material from entering the trachea by respectively closing the true vocal cords, false vocal folds, and aryepiglottic folds. Contraction of the lower pharyngeal constrictor is followed by relaxation of the cricopharyngeal muscle, allowing the bolus to pass into the esophagus. Esophogeal Phase
Due to insufficient closure of the larynx Oral cavity doesn’t close well in preparatory phase or swallow reflex not intitated when bolus enters pharnx When larynx opens, bolus enters into trachea Esophogeal Phase Peristaltic muscle action pushes food through espophagus to stomach OR aspiration occurs
Excellent Videoflouroscopic View of Swallowing Phases
Transitioning from Nipple Feeding to strained foods…
The feeder has to gently scrape the food off on the baby’s upper lip, & the food usually has to be put back in several times after the baby has spit it out. When would this be a real problem?
This spitting out is usually a result of immaturity rather than a dislike for the food. This is messy time!
Presenting strained foods before a baby is physically just gives them more practice taking strained foods in an immature way When strained or pureed foods are first presented, babies usually try to suckle. The suckling tongue action begins as soon as the spoon touches the lips. Doesn’t move downward on the spoon to remove the food. The closer the baby is developmentally to 6 months , the shorter the messy period, and the sooner the baby gains more control
When children have muscles that are too floppy or weak, they may need to have their faces “wakened up” with a brisk washcloth rub before the presentation of the food.
Can also use Rood technique: quick ms. stretch and ice as last resort
Inhibition Facilitation Muscle tightness interferes with the child’s ability to close lips on the spoon. Incorporate facial massage in direction of protraction prior to the feeding to inhibit tight ms.
Tongue lateralization is necessary for placing food over the teeth and keeping it there during the whole chewing process. Without good sideways tongue movement, food falls off the teeth and isn’t well-chewed.
You can use the NUK brush with the child, or let the child use it while you supervise. But a child should NEVER be left alone with the brush because choking can occur.