In order for students in the field of Speech Pathology to understand, diagnose and provide treatment for persons with dysphagia, there must first be a thorough understanding of a "normal" swallow.

The act of deglutition is divided into four phases:

1. Oral Preparatory Phase - food is manipulated in the mouth and masticated (chewed) if necessary in order to reduce food to a consistency which can be swallowed.
2. Oral Phase - the tongue propels food posteriorly until the pharyngeal swallow is triggered.
3. Pharyngeal Phase - once the pharyngeal swallow is triggered, the bolus (cohesive ball of food) is transported through the pharynx.
4. Esophageal Phase - esophageal peristalsis carries the bolus from the cricopharyngeal juncture or upper esophageal sphincter (UES) through the esophagus to the Lower Esophageal Sphincter (LES).

This tutorial will allow the student to view the first three phases of swallowing via Videofluoroscopy.

The subject is a 47 year old male with no history of swallowing problems. The videofluoroscopy segments include swallowing of an 1/3 Teaspoon Honey Consistency Liquid (lateral view).

Videofluoroscopy Segment

Because this is a normal swallow, it happens very quickly. You will want to watch each segment repeatedly and look for one component at a time.

1/3 Teaspoon Honey Consistency -Lateral View

• Watch the entire Honey Consistency segment, first.
• Then, watch the Honey Consistency segment according to following components:
  1. Posterior movement of the tongue to move the bolus back
  2. Elevation and retraction of the velum and complete closure of the velopharyngeal port
  3. Elevation and anterior movement of the hyoid and larynx
  4. Bolus transported into valleculae
  5. Backward movement of the epiglottis which protects the airway
• Notice how there is virtually not residue of food in the pharynx after the swallows. 

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Special thanks to St.Mary's/Duluth Clinic (SMDC) Radiology and Speech Pathology departments for providing the videofluroscopy studies of the normal adult.