Schluckakt

The Schluckakt, or swallowing act, is the coordinated sequence of muscular activity that transfers a bolus from the oral cavity to the stomach while safeguarding the airway. It comprises three overlapping phases: the oral phase, the pharyngeal phase, and the esophageal phase. In the oral phase, the bolus is formed and propelled by voluntary tongue movements against the hard palate toward the oropharynx. The pharyngeal phase is rapid and largely involuntary; the soft palate elevates to seal the nasopharynx, the larynx elevates, the epiglottis folds over the airway, and the upper esophageal sphincter opens to permit bolus entry. The esophageal phase uses peristaltic waves to move the bolus through the esophagus to the stomach, aided by gravity in certain conditions.

Neural control involves brainstem circuits acting as a central pattern generator, with afferent input from cranial nerves V, IX, and XII, and motor output via cranial nerves IX, X, and XII. The process relies on coordinated timing between respiration and swallowing to minimize aspiration risk.

Dysfunction of the Schluckakt, or dysphagia, can result from neurologic disease, aging, or structural problems and increases the risk of food or liquid entering the airway (aspiration). Clinicians assess swallowing with videofluoroscopy (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES). Management may include therapy to strengthen muscles, compensatory strategies, dietary modifications, and, when needed, feeding adaptations.