Next time you have something to eat or drink, think about the

structures that might be involved. Some are obvious-- such as the

jaw, the lips, the teeth and the tongue-- as you take in and move
food and drink around the mouth. Others are less obvious-- the
bony, hard palate-- or roof of the mouth, the muscles within the
cheeks, the soft palate at the back of the mouth all play a role.
Within the pharynx, or throat, the larynx, or voice box, plays a
very important role. We'll be looking at some of these structures
in more detail and their function.

The normal swallow is a highly-coordinated pattern of movements.

It is sometimes described as a reflex. However, this is only true in
very young infants. By the time a child reaches the age of two
years old, she or he will have developed a normal adult swallow
pattern with some limitations-- for example, in the type of foods
they can manage.

The adult normal swallow allows an individual to manage a wide

range of food and drink of varying volumes, temperatures,
textures, and consistencies. There are three main phases to the
normal swallow, which are aligned on both neurological motor and
activity and sensory feedback. These are the oral, pharyngeal, and
oesophageal phases of swallowing.

The oral phase is sometimes divided into two. One is called oral
preparation, and the other oral transit. I'm going to describe both
of them. On this diagram, note the position of the lips at the front
of the mouth and the soft palate at the back. Also take note of
the shapes of the tongue. During oral preparation, the jaw, lips,
tongue, and soft palate are involved in retaining, controlling, and
manipulating food and drink within the oral cavity.

The jaw allows opening and closure of the mouth, and its lateral,
rotatory movements are involved in chewing. You might observe
that in yourself and others. The lips assist with taking material
into the mouth and retaining materials to prevent spillage or
drooling. The tongue moves food from side to side and helps clear
material from the teeth and the crevices of the mouth. The soft
palate at the back of the mouth prevents material falling into
pharynx too early. At the same time, saliva is produced to
lubricate dry materials to allow for a smooth transit.

The oral transit phase occurs once preparation is complete. A

bundle of material, or bolus, is formed and held in the midline of
the tongue. The front, back, and sides of the tongue are elevated
to form a well for the bolus. This happens with both food and
drink-- again, something you may feel next time you're eating and
drinking. It may only be momentary for drinks. It takes
approximately one second for water to travel through the mouth
and into the pharynx.

Once preparation is complete, the bolus is propelled towards the

pharynx by backward motion of the tongue. The front, middle, and
back of the tongue press successively against the hard palates
and upper jaw and push the bolus backwards. The soft palate rises
to prevent material entering the nasal cavity. If you've ever
laughed while eating and drinking, you will know how
uncomfortable it is for material to enter the nose.
This diagram shows the end of the oral phase and the beginning of
the pharyngeal phase. Note the position of the soft palate and the
front and the middle of the tongue. The lips are closed at this
stage to exert additional pressure on the bolus. Triggering of the
pharyngeal phase is initiated by backward motion of the tongue
and immediate detection of the bolus within the pharynx. And
timing and coordination are crucial, because the pharynx provides
a shared passage for food and drink and for respiration.

When we're breathing, the entrance to the larynx and the vocal
folds must be open to allow passage of air. These structures are
indicated in the first diagram you saw. The primary purpose of the
pharyngeal phase of swallowing is to provide a mechanism to
prevent food and drink entering the airway. Protection of the
airway is achieved by breath hold, as the paired vocal chords
within the larynx close tightly. At the same time, the larynx moves
upwards and forward. If you feel the front of your neck during a
swallow, you will feel that upward and forward movement. Or
again, you might observe it in others.

During this phase, the epiglottis closes over the closed larynx,
diverting the bolus towards the oesophagus. The upward
movement of the larynx helps to relax the muscle at the top of the
oesophagus, which is called the upper oesophageal sphincter. At
the same time, the muscular pharyngeal walls exert pressure on
the bolus, pushing it into the oesophagus. Once the bolus is
passed through the sphincter, the airway reopens and breathing
resumes.
The oesophageal phase allows transport of the bolus through the
oesophagus to the stomach. Movement is via a series of waves of
muscular contractions, which is called peristalsis. The muscles
below the bolus relax, and above the bolus contract until the
bolus reaches the stomach.