I Out-Clevered Myself

29 Nov

Again.  And yes, I just invented the new word clevered.  As in the act of being clever.  Or in my case, not so much.  So here is an entertaining story, though there is a lot of swallowing anatomy you need to brush up on (probably) to fully appreciate it.

So I’m taking my (LAST-YAY!) Anatomy exam, reading carefully per the usual, and I come upon this question:  “In what stage of swallowing does saliva mix with the bolus?”  Or something to that effect–I obviously don’t have a photographic memory.

Anyhow, it was a word bank consisting of each of the 4 stages:

A]  Oral Prepatory (stage 1 where food is manipulated and maticated until a swallow-able bolus is formed),

B]  Oral (posterior propulsion of bolus toward pharynx),

C]  Pharyngeal (bolus travels through the pharynx),

and D]  Esophogeal (bolus moves from Upper Esophogeal Sphinctor to the Lower Esophogeal Sphinctor.

But here was my logic when I was considering the question.  There are 3 major salivary glands (that we learned about) in/near the oral cavity:

1.  The sublingual under the tongue that produces a protein-rich mucous fluid that is a ropey quality to encapsulate material and form the bolus.

2.  The submandibular that produces both serous and mucous fluid to lubricate the bolus.

3.  The parotid, located between the anterior and posterior faucial piller (this fact will come into play later!) that produces serous fluid that helps propel the bolus into and through the pharynx rapidly.

Got all that?

SO, there had to be 2 correct answers.  Because the sublingual collects residue in the oral-prep phase AND the parotid helps initiate a fast and effiecient pharyngeal swallow.  I made my case to the prof, who exasperated at my over-thinking, asked which was MORE important.

I couldn’t decide.  If residue wasn’t collected and a bolus wasn’t formed at all a person could starve, or at least lose weight.  BUT if the pharyngeal swallow is delayed or inefficient, a person could choke or aspirate and die.  So Both.  Pretty.  Important.

I explained this, and wanting to be rid of me and my crazy-meticulous questions, reading into HER questions, she told me to put both.  So I walked back to my desk, satisfied my answer was correct and complete and marked A and C.  Oral-Prep and Pharyngeal.  Then, as always, when I was going back through my test to make sure I hadn’t skipped anything or made any stupid mistakes and saw that A and C.  Oops!  I accidently put C when I meant B, I thought to myself hastily changing the answer, and thanking my lucky stars I had double checked.

I turned in the test, left the room, and started on my between class walk on the trail, thinking about the exam.  And do you know what I thought?  The pharyngeal phase is initiated when any part of the bolus moves past the anterior faucial piller.  And?  The parotid salivary gland is behind that-DOH!  I had changed my second answer to B-oral phase, when it WAS in fact C, pharyngeal.  Damn, after making a huge deal about that question I STILL got it wrong.

I kill myself.


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