Anatomic considerations

An understanding of the anatomy of the pharynx is essential to a thorough understanding of the swallowing process. The anatomy changes during development. The tongue, the soft palate and the arytenoid mass (arytenoid cartilage, false vocal cords and true vocal cords) are larger relative to their surrounding chambers when compared with the adult.12 In the infant, the tongue lies entirely within the oral cavity, resulting in a small orophar-ynx.12,13 In addition, a sucking pad, composed of densely compacted fatty tissue that further reduces the size of the oral cavity, stabilizes the lateral walls of the oral cavity. The larynx lies high in the infant, and the tip of the epiglottis extends to and may overlap the soft palate. These anatomic relationships are ideal for the normal infant feeding pattern of sucking or suckling feeding a breast or a bottle in a recumbent position.14 In the infant, the larynx sits high in the neck at the level of vertebrae C1 to C3, allowing for the velum, tongue and epiglottis to approximate, thereby functionally separating the respiratory and digestive tracts. This separation allows the infant to breathe and feed safely. By age of 2-3 years, the larynx descends, decreasing the separation of the swallowing and digestive tracts2,15 (Figure 15.1).

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