Observations Indicating Impaired Swallowing

• Drooling or loss of food from the mouth - due to impaired lip closure (impaired anterior containment)
  
  
• Collection of material in the anterior and lateral sulci during mastication - due to reduced tone in cheek musculature
  
  
• Reduced range of movement in lower jaw
  
  
• Reduced range, shaping, or coordination of tongue movements
  
  
• Premature escape of material from the mouth into the pharynx due to impaired forward motion of the soft palate or impaired elevation of the back of the tongue
  
  

• Break-up of the bolus or its irregular propulsion from the front of the mouth backward to the pharynx - due to impaired ability of the tongue to elevate and make complete contact with the palate or to form a sequential wave from front to back against the palate in order to strip the bolus completely and smoothly towards the pharynx (impaired posterior containment)
  
  

• Loss of the bolus over the back of the tongue into the pharynx where it may collect in the open valleculae, pyriform sinuses, or airway - due to delayed triggering of the neuromuscular sequence in the pharynx which permits the bolus to enter the pharynx before the pharyngeal phase has been activated
  
  
• Reflux into the nose due to reduced soft-palate closure
  
  
• Pooling of material in the pharynx, valleculae, and/or pyriform sinuses after the swallow - due to weak pharyngeal peristalsis by the pharyngeal constrictor muscles
  
  
• Passage of the bolus down only one side of the pharynx due either to a mass on the contralateral side or to paralysis of the ipsilateral side
  
  
• Slow, reduced, or absent elevation of the larynx (watch the hyoid bone)
  
  
• Failure of the epiglottis to fold over the opening to the airway
  
  
• Aspiration of barium into the subglottic trachea - due to failure of the vocal cords to fully adduct during swallowing
  
  
• Delayed opening, incomplete opening, or premature closure of the UES - due to cricopharyngeus muscle dysfunction