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Velopharyngeal Function

2/17/00

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Soft Palate

• Posterior extension of soft palate

• Composed of muscular fibers

• Movement changes volume & shape of the nasal & oral cavities

• Speech: nasal-nonasal phonetic distinction– “Closed”- Soft palate elevated and seals against posterior

pharyngeal wall– “Meaning”- Soft palate is lowered (acoustic energy passes

through nasal cavity)

• Swallow: Soft palate closes when bolus passes from oral cavity to pharynx

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Muscles: Soft Palate

• Levator veli palatini

• Tensor veli palatini

• Uvula

• Palatoglossus

• Palatopharyngeus

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Levator Palatini

TemporalBone

• Elevates the soft palate

• Pull soft palate toward

post. pharyngeal wall

• Dilates eustachian tube

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Tensor Veli PalatiniEustachian

Tube

• Dilation of eustachian tube

• Tenses the palate assisting in velopharyngeal closure

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Uvula

• Medial & posterior portions of the soft palate

• Arises from posterior nasal spine of palatine bone

& palatal aponeurosis

• Fibers run the length of the soft palate

• Inserts into mucous membrane of the velum

• Contraction shortens the velum, bunching it up

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Palatoglossus

• Anterior facial pillars

•Depresses sides of soft palate

•Pulls sides of tongue up and back

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Palatopharyngeus

Soft Palate

Palatoglossus

Palatine Tonsil

Palatopharyngeus

AnteriorFaucial

Arch

PosteriorFaucial

Arch

• Posterior facial pillar• Depress soft palate• Elevate pharynx or larynx

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Patterns: Velopharyngeal Closure• Basic action the same in speech & swallowing

– Close the entry into the nasal cavity or open it

• Sex differences:– Males velum forms acute angle in the orientation to the

PPW– Females have a right angle orientation– Extent of the area of the velopharyngeal seal is greater

in females– Midpoint of closure in the nasopharynx

• Superior to palate in males

• Inferior to palate in females

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Patterns of Velopharyngeal

Action

A.

B.

C.

D.

VelumVelopharyngeal

Port

LateralPharyngeal

Wall

Passavant’sRidge

A. Coronal (A-P movement of velum)

B. Sagittal (Lateral pharyngeal wall movement)

C. Circular (Equal movement of lateral pharyngeal wall and velum)

D. Circular with Passavant’s Ridge (Lateral pharyngeal wall, velum & posterior pharyngeal wall)

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Velopharyngeal Function & Age

• 3- 5 years: velar-adenoidal valving– exploits large adenoidal mass in young children

• Nasal airway narrow

• Adenoid atrophy changes pattern

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Velopharyngeal Actions• Velum Elevation:

– Levator Palatini

– Velar positioning:• Levator veli palatini

• Palatoglossus

• Palatopharyngeus

•Velum Lowering:–Muscle contraction

•Palatoglossus

•Palatopharyngeus

–Gravity

–Tissue Elasticity

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Swallowing

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Deglutition

• Main purpose: Transportation of bolus (mass of masticated food ready to be swallowed) from oral cavity to the stomach

• Sequence of Muscular Action:– Trap bolus in the anterior region of oral cavity– Move the bolus from the mouth to entrance of pharynx– Admit the bolus into the esophagus, while entrance into

larynx is closed– Transport bolus to esophagus to stomach

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Swallow: Structures Involved• Lips (Anterior Seal)

• Tongue (Anterior Seal)

• Soft Palate (Closes velopharynx-Midpalatal) (Opens-Esophageal)

• Pharynx (Opens for bolus)

• Larynx (Vocal folds close)

• Esophagus (Superior sphincter opens-Peristaltic transport)

• Interruption of respiration: Apneic Interval

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Stage Descriptions

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Containment Stage

• Anterior seal formed by the lips & tongue tip or blade

• Bolus held in a depression at the front of the tongue

• Dorsum of tongue arches upward to assist bolus containment

• Tongue performs a pooling action to contain the bolus

• Posterior seal by the soft palate (descending to make contact with the tongue

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Midpalatal Stage• Bolus squeezed aborally (away from mouth)

by progressive wavelike elevation of the tongue (anterior)

• Dorsum of tongue lowered to receive bolus

• Soft palate elevated in advance of the bolus to open the oropharyngeal channel & close the VP port

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Pharyngeal Compression Stage

• Begins: Bolus reaches faucial pillars & soft palate

• Onset of reflexive control of deglutition

– Cessation of respiratory activity (apnea)

• Tongue flexes backward on hyoid bone to thrust bolus posteriorly into the pharynx

– Vigorous tongue motion necessary

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Pharyngeal Engulfing Stage• Larynx moves superior-anterior to tuck under the root of the tongue

• Epiglottis tips downward & backward to protect the opening into the larynx

• False & true vocal folds adduct to form a laryngeal constriction– prevents solid & liquid from entering the larynx

• Elevation of pharyngeal tube to “engulf” bolus– Peristaltic wave: Involuntary contraction

• Superior esophageal sphincter opens receiving bolus

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Esophageal Stage

• Bolus moved by esophageal peristaltic contraction to the gastroesophageal sphincter (entrance to stomach)

• Respiration begins, soft palate descends to rest position

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Stages of Swallow

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Bolus Transport Time

• Oropharyngeal Time= 2 seconds (young adults); 3-4 seconds (older adults)

• Esophageal Time= 0.5-1 second– liquids have faster times

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References

• Arvedson, J.C., & Rogers, B.T. (1993). Pediatric swallowing and feeding disorders. Journal of Medical Speech Language Pathology, 1, 203-221.

• Kennedy, J.G., III, & Kent, R.D. (1985). Anatomy and physiology of deglutition and related functions. Seminars in Speech and Language, 6, 257-273.