The role of the hypopharyngeal contraction. Rhinolalia Materials and methods

Assistant at the Department of Pediatric Dentistry and Orthodontics of the First MDMU named after I. M. Sechenova

Treatment of children with CAHN is one of the most difficult tasks of cervical pneumocele surgery. The problem lies with the corrected anatomical defect, and with the fully renewed functions of the organ. The integrity of the anatomical structures of organs can be restored using various plastic surgeries. However, regardless of the variety of methods, in a number of cases, surgical interventions do not lead to the renewal of the integrity of the NGC, which results in a lack of its function (A. E. Gutsan, 1982; E. I. Samar, 1986; L. N. Gerasimov, 1991; A A. Mamedov, 1997-2012; R. Musgraveetal., 1960; R. O'Neal, 1971; C. Dufresne 1985; S. Cohenetal., 1991; C. Hung-Chietal., 1992; ., 1993; A. E. Rintala , 1980; J. D. Smith, 1995).

Classification of insufficiency of the palatine ring

In a number of classifications of dysfunction of the OGK, in our opinion, the level of dysfunction of structures is not covered, there is a comprehensive list of reasons for the dysfunction in their interrelationship with the dysfunction cii NGK.

Why do we see such an important need for a detailed re-examination and analysis of the reasons for the destruction of the language?

According to Pershe, only for certain reasons - obviously up to the stage of destruction of the frailty of the structures of the OGN - it is possible to accurately determine the tactics of surgical rehabilitation of patients with NGN.

In a different way, it is necessary to gradually treat the causes of the central character (zocrema, suppression of the psychomovic development), as well as the mental development, the emotional-volitional sphere. The disruption of language in other worlds (due to the nature of mental discord) negatively influences the mental development of the child and is driven out of its conscious activity. They can call out inappropriate behavior, inflict on the pink development, especially the formation of higher levels of cognitive activity.

In third In our opinion, the reason for the culprit of impaired speech is the delay in the time of performing the primary uranoplasty, if the operation is performed later than the 5th age of the patient: at that time, the patient has already developed pathological stereotypes of speech. Therefore, diagnosis of brain damage may be carried out simultaneously by a surgeon, a speech therapist, a neurologist, a psychologist, and an orthodontist.

The reason for the loss of mobility is the time it takes to perform the primary uranoplasty, if the operation is performed later than the patient’s 5th century

Striving for an objective diagnosis of the most common causes, 37-line clinical evidence, which includes the completion of complex diagnostics and comprehensive rehabilitation of a large group of patients with NGN, is a natural prize led to the classification we created, based on the clinical assessment of the anatomical and functional characteristics of the function of the NGC structures, indicated on the endoscopic follow-up platform

Anatomical and functional endoscopic classification of insufficiency of the hypopharyngeal ring (PHR) (A. A. Mamedov, 1996)

• Type I: insufficiency of NGK, which is due to the additional rotten fragility of the entire subpalval firank (NZ).
• Type II: insufficiency of NGK, which is due to the additional rotten fragility of one BSG.
• Type III: insufficiency of NGK, which is due to the additional rotten fragility of both BSG.
• Type IV: insufficiency of oil and gas complex, which is due to the additional rotten fragility of all oil and gas complex structures.
• Type V: insufficiency of NGC, which occurred after velopharyngoplasty, pharyngoplasty.

The classification we have proposed (grouping the causes of insufficiency in the function of the structures of the OGK) allows in practice to choose such tactics of surgical treatment, in any case, to be used in the process of surgical intervention Most of the loose fabrics of the structures of the Oil and Gas Company. The significant level of frailty of the skin structures fragmentarily and at the same time allows us to recommend a specific surgical method aimed at correcting the smallest frailty tissues and reducing their negative impact on the mechanism of NGK circulation.

The level of friability of the NGC structures is determined by us during endoscopic fastening of patients: good friability, satisfactory friability, poor friability (we did not evaluate the degree of friability of the GGC, the fragments do not take part in the mechanism of change).

Material and method

On the basis of clinical evidence and objective methods of complex treatment of patients with NGN, our work revealed that the majority of patients, unfortunately, the initial uranoplasty was performed later in life, in those older 5 children (80 children), and more than 6 children underwent primary uranoplasty Bula Vikonana at the optimal time - from 2 to 4 years - in the form of two-stage uranoplasty (Stage I - plastic surgery of the soft palate - veloplasty; the other stage - plastic surgery between the hard palate).

In 9 patients, after a single surgical removal of the NGN using the established Schoenborn method or its modification, it was saved. All patients suffered from poor language impairment in the appearance of nasality, associated with the inferior function of the NGC in general or its surrounding structures. In addition, the majority of patients were diagnosed with chronic illness of the ENT organs.

The high positive result of the operation for ligament obstruction, which is indicated, can create the illusion of the complexity of the surgical delivery technique.

Let us confirm our advanced evidence (classification of the causes of NGN) of the understanding of current specialized practice, rich clinical evidence of surgical treatment of patients at VRN (1975-2012). ), a unique complex of fundamentally new modern diagnostic technologies for the treatment of patients in this complex field of thoracic surgery. In this case, the operator's primary responsibility is to choose surgical tactics and to determine the relationship between anatomical and functional disorders with impaired language and types of dysfunction of the structures of the cervical system.

I would like to point out that the investigators who analyzed the function of the oil and gas condensate and its connections with the oil and gas condensate did not study the same assessment of the fragility of the oil and gas condensate structures. We see that the established classification allows us to obtain a reliable picture of the qualitative assessment of the degree of fragility of the structures of the oil and gas complex and the relationship with the damage to the language, thus allowing the choice of surgical tactics effective treatment of patients, which will greatly ensure the positive result of treatment, and therefore the renewal of language .

Methods for relieving subpalatal pharyngeal insufficiency without vicarious pharyngeal clamps

The operational methods for eliminating NGN are very varied and effective, and the results are super clear. When the NGN was removed by us (A. A. Mamedov, 1986), using a method of repair, when a piece defect was created in the area of ​​the soft palate and one small mucous-osseous valve (SNL) was sewn into it, the wound surface of which was closed with another large SNL ( Fig. 1). The same procedure is used to reach the pharyngeal ring, which is close to the posterior wall of the pharynx with vicoristic sublingual Z-plasty (Fig. 2).

Small 1. Extension of the OGN with viscostannia, thrown over and spherical and moved along the plane of the muco-osseous clefts (A. Mamedov, 1986). Small 2. Suspension of the NGN with vicarious Z-plasty in the oral and nasal mucous-muscle ball of the soft palate, tissue of the lateral wall of the pharynx from both sides (A. Mamedov, 1995).

In this type (Fig. 2) the greater part of the soft palate is reached along the midline, the sound of the pharyngeal ring is reached through the arch of the same part of the tissue of the side walls of the pharynx and the soft pharynx Day by day, and not to bring all structures close and to the sound of the oil and gas complex and close all structures to the posterior pharynx wall. This method changes the size of the NHC and allows you to insert a turn through the nose under the hour of spontaneous thought.

Although most of the descriptions of methods are named after one or many surgeons who took part in the development, often numerous modifications are based on the basis of the initial description. In this case, all the senses are “the understanding of other people’s ways of people’s own” (A. Mamedov, 1998). One center or surgeon may adopt a technique as described initially, while variation in another location will give rise to numerous modifications. It is not possible to formally compare both methods and methods, since the fragments are practically too rich to lie with the operator. Pediatric plastic surgery in the hands of one surgeon can cause completely different results in the hands of another surgeon (A. Mamedov, 1998, J. Bardach, K. Salyer, 1991).

Finally, it should be emphasized that synchronization plays an important role in the interpretation of results. The procedure that the surgeon performs on patients of different age groups can produce different results also through the complex interaction between the form of pathology, stage, method of operation and the age of the patient (M. Lewis, 1 992). In this part of the article, we have not yet described all the methods of suppression of the urinary tract without pharyngeal clamps. There's still a stink in the rozrobtsi.

Methods for relieving hypopharyngeal insufficiency with vicarious pharyngeal clavicles

Velopharyngoplasty- molding of a permanent clasp of the mucous membrane, the submucosal base and the pulp between the structures of the soft palate and the posterior wall of the pharynx (PSG) for the relief of NGN - praised by most surgeons today.

The high positive result of the operation for the removal of NGN, which is indicated by a wealth of successors, can create the illusion of the incomprehensibility of the surgical delivery technique. However, after this operation, there is no doubt that the best results of updating the anatomy and function of the OGN can be obtained, especially in patients in whom the initial uranoplasty has ended with the NGN.

Operations with the withdrawal of NGN may be carried out at specialized financial institutions

However, the diversity of pharyngeal clamps (on the upper, lower leg, from the middle third, the side third of the GSG), as well as the different methods of their lining, require high professionalism . Lіkuvannya of such Patziyntiv Slizes at the specialized centers, de є a leaps for the spindle, all the non -oxide for the comprehensive dial of the vice of the likovanni on the All -ethno Etapas Reabilitatsiy.

As for the illusion of inconsistency, it is clear that operations involving the removal of NGN are highly professional operational procedures and can be carried out in specialized medical institutions. This can serve as a recommendation to primary surgeons and surgeons with extensive work experience, but do not hesitate to hand over the NGN.

NGN is a kind of “social marker” of the patient, intervening spilkuvaniya, anti-professional “obsessions”, “movement galm” in many ways directly forming the psychoemotional sphere and social adaptation of particularities. That’s why we listen so casually for the ways of the NGN hem and the latest language, as the brightest communicative ability of people.

Negotiated

In 1876 D. Schoenborn proposed an operation, the idea of ​​which is attributed to Trendelenburg: on the posterior wall of the pharynx, a pharyngeal valve is created on the lower leg, 4-5 cm long and 2 cm wide. the bast shoes are turned down to the bottom, the tops of them are sewn at the edge of the soft Monday A similar technique was studied by J. Shede (1889), Bardenheuer (1892).

U 1924 r. the operation for the removal of NGN was described by W. Rosenthal and named after him. The technique of W. Rosenthal differs little from the technique of D. Schoenborn: the valve includes the mucous-muscle ball to the prespinal fascia.

A great contribution to the development of the technique of vikoristanny pharyngeal valve during velopharyngoplasty was made by Fruend (1927), E. Padgett (1930), Sanvenero-Rosseli (1935), H. Marino, R. Segre (1950), R. Moran (1951), H. Conway (1951), F. Dunn (1951, 1952), R. Trauner (1952, 1953), M. Ruch (1953), M. Retit, Papillon-Leage, M. Psaume (1955), R. Stark, C .DeHaan (1960), J. Owsleyetal. (1966), K. Ousterhout, R. Jobe, R. Chase (1971).

V. I. Zausaev (1956) and E. U. Fomicheva (1958) described the stasis of the pharyngeal valve for plastic surgery of the soft palate defect. However, the removal of functional and physical results did not satisfy the authors, as a result of which the results of the FO proposed by these authors did not result in widespread stagnation. V. S. Dmitrieva and R. L. Lando (1968) used the Rauer and Schoenboer-Rosenthal methods to equalize the results of palpebral plastic surgery on 28 patients. There were no noticeable changes in sound in patients consistent with preoperative results.

A. A. Vodotika (1970), vikoristovav pharyngeal valve on the upper scissor, suturing it in the previously prepared bed of the middle third of the soft palate. Only 3 patients out of 48 had external separation; in others, velopharyngoplasty gave positive results.

At the Clinic of Surgical Dentistry of the Dnipropetrovsk Medical Institute. S. Malevich from spivat. (1970) 35 operations were performed on the vicarious pharyngeal valve on the upper and lower legs during primary uranoplasty for NGN. The compilation was not prevented, it was indicated that the language was abbreviated.

Vodotika vikoristovav pharyngeal valve on the upper leg, suturing it in the bed of the middle third of the soft palate. Only 3 patients from 48 had external separation

We appreciate that with the current “gentle” methods of primary uranoplasty, which is carried out at ages 1.5 to 3 years of life, satisfactory functional results are obtained in most cases, the need for surgery This has changed due to the removal of NGN. The results of our follow-up practice have shown that in case of contracted NGN, it is necessary to vikorize the tissue of the BSG. So, since 1982. at the clinic, professional doctor. L. E. Frolova (Moscow), having eliminated the stagnant method of NGN substitution in the vikoristanny of the Federal District, founded in the middle third of the ZSG.

As a result of these studies, the “Method of velopharyngoplasty” was developed (L. E. Frolova, F. M. Khitrov, A. A. Mamedov, 1986), which lies in the incised FO on the upper lower leg from the middle third of the GSG and lining Yogo do textile m 'What a mess, to the side walls of the throat. The validity of this method was established by D. Schoenborn in 1876. There are those that the FO on the upper leg of the vein is hemmed not only to the NZ tissues, but also to the BSG tissues. Tim himself reaches the fate of all structures of the oil and gas complex in the mechanism of change, the process of updating the language (Fig. 3).

Functional and physical results, obtained by auditory speech therapy assessment, endoscopy, were assessed as positive.

Reduced palatopharyngeal insufficiency, which is blamed for the destruction of one side wall of the pharynx
In case of insufficiency of NGC, which is blamed for the poor looseness of one of the side walls of the pharynx (indicated by an endoscopic path), a surgical method is proposed using a vicarious FO with one of the sides tretin ZSG. The chosen place for opening the pharyngeal valve should lie on the side of the least friable one of the side walls of the pharynx (Fig. 4).

Small 4a. Pharyngoplasty. Suspension of the NGN from the vicors of the pharyngeal valve, located in the lateral third of the posterior wall (A. Mamedov, 1989). Small 4b. Photo of a patient with NGN before surgery.
Small 4th century Photo of the patient 1 day after the operation. Small 4g. Photo of the patient 1 time after the operation.

This method has been studied by us in patients with left-sided or right-sided tissue laxity of the BSG, who underwent surgery for the reduction of LFN.

In the postoperative period, a decrease in the air flow through the nasal passages was observed, and the restoration of good friability of the BSG, as determined by the endoscopic method, was expected no earlier than after 4-6 months. With control follow-up after 6-8 months. It was established that the NGN has been reduced and the tissue structures of the NGK have good friability.

Symptomatic pharyngeal insufficiency, which is responsible for the destruction of both lateral walls of the pharynx

In case of insufficiency of NGC, if the cause of the damaged structure is the injured lateral walls of the pharynx, we use a vicoristic method, directly to obtain the mechanism of contraction of the smallest fragile structures, in this case, the injured lateral walls of the pharynx (Fig. 5-6). Small 6. Photo of the patient 1 time after the operation.

Visnovok

We performs the complex of the XIRURGICHIC METHOPS OSENNE of the NGN PISLI of the primary uranoplasty, cycling -firingoplasty, pharyngoplastics, hidden on the vitality of the anatically, the functions of the NGK, on ​​the vasunsnnya of the pathologic mechanism of the zyman.

Based on the available data, it is possible to draw conclusions about those that a systematic approach to the problem of updating a language allows:

• solve the problem of rehabilitation on the basis of the historical data of endoscopic diagnostics, which makes it possible to determine which structures of the NGC are the least fragile and in what way they take part in the mechanism of change, which is the main component in Updated movie;
• It is important to determine the indications before using any other method depending on the level of participation in the mechanism of skin structure and the entire NGC.

The basis of surgical methods is based on the methods of tightening the function of the NGC (spectral analysis of the brain, electrodiagnostics of the meat structures of the NGC, etc.), which allows for the greatest accuracy in choosing the method of ablation NGN with regulation of localization of the pathological process (in NZ, one BSG, both BSG, all structures, which, when completed, allows you to achieve the goals of rehabilitation and achieve the renewal of normal language.

The anatomical and functional classification of NGN that we have established allows:

• differentiated selection of optimal methods of treatment with the use of new technological techniques;
• it was differentiated by choosing a surgical method with the aim of calculating the stage of destruction of the frailty of the structures of the cerebral hemorrhage, determined by an endoscopic method in a complex with all types of quilting.

The proposed complex of approaches had a vikoristan method of reducing the NGN on the basis of the vikoristan pharyngeal clamps, located in the middle third of the GSG, the side thirds (right-handed or left-handed), closely on the side of the collapse of the BSG. All the methods are based on the creation of a single functional fully anatomical structure - the hypopharyngeal ring, which includes all its elements (NZ, BSG, ZSG). Other methods of adoption will be presented in future publications.

Literature

1. Vodotika A. A. Plastic surgery of congenital clefts of the palate due to stiffening of the valve from the posterior wall of the pharynx. dis. ...cand. honey. Sci. – Dnipropetrovsk, 1970.
2. Gerasimova L. P. An up-to-date analysis of the effectiveness of various methods of complex therapy for children with cleft lip and palate: Author's abstract. dis. …. Ph.D. honey. Sci. – Perm, 1991. – 21 p.
3. Gutsan A. E. Uranoplasty with mutually reversible valves. – Chisinau: Shtintsia, 1982. – 94 p.
4. Dmitrieva V. S., Lando R. L. Surgical treatment of congenital and postoperative defects of the palate. – M., 1968.
5. Zausa V.I. Plastic surgery of the soft palate with a mucus-muscle plug from the posterior wall of the pharynx. Dentistry, 1956; 3:22-25.
6. Malevich E. S., Malevich O. E., Vodotika A. A. Pharyngeal-palatal valve during plastic surgery of congenital palatal clefts// Proceedings of the V All-Union Congress of Dentists. – M., 1970. – P. 188-191.
7. Mamedov A. A., Vasiliev A. R., Volkhina N. N., Ionova Zh. St. Endoscopic method for assessing the function of the palatal ring: a methodological sheet for doctors. – Yekaterinburg, 1996. – P. 48.
8. Mamedov A. A. Palatopharyngeal insufficiency and pharyngeal insufficiency. / Zb. Sci. tr., volume XXXII, Tbilisi State Medical University. – Tbilisi, 1996. – P. 449-450.
9. Mamedov A. A. Pharyngoplasty for insufficiency of the palatal ring// New technologies in dentistry and maxillofacial surgery. Abstracts of the V International Symposium, Khabarovsk, 8-12 linya. – Vydavnitstvo of the Khabarovsk State Medical Institute, 1996. – P. 51.

The latest list of literature can be found in the editorial office

To understand the mechanism behind the occurrence of these anomalies, consider the process of lip and palate formation.

The birth of the lip and palate begins in the 5th-10th stage of intrauterine life; The section of the primary oral cavity is divided into two sections:

empty company and empty bow.

This is due to the creation of partial protrusions of the palatal ridges on the internal surfaces of the upper slit plates. On the cob eighth year The edges of the palatal ridges are straight and slid downwards and lie on the floor of the mouth, on the sides of the tongue. The lower gap is getting larger. This space and lowering of the tongue make it possible to move the palatal juveniles from a vertical position to a horizontal one.

At the end another month The life of the embryo at the edge of the palatal juveniles begins to unite with each other, begins in the anterior sections and gradually expands backwards. The septum of the oral bay is the rudiment of the hard and soft palate. It strengthens the remaining empty mouth from the nasal emptying. At the same time, the nasal septum begins to grow, rising up from the palate and dividing the nasal cavity into the right and left nasal chambers.

Until the 11th year, the lip and the sky become firmer,

and until the end of the 12th year, fragments of the soft day are growing one by one. The formation of the lip and palate at the germ on the adjacent ridges of the development is the same as in case of non-growth, which is observed in the clinic: in case of a continuous bilateral cleft defect of the lip, alveolar process and palate to non-growth Only a soft palate and only a small tongue or an undeveloped lip. Intellectually, this lip and palate can be called a physiological gorge. With the infusion of one or many overloaded etiological factors, the growth of the edges of the “physiological gaps” is tightened, which leads to congenital ungrowth of the lips, palate or their undersides.

One of the pathogenetic factors of non-growth of the halves of the palate, obviously, is the pressure of the tongue, the dimensions of which, as a result of discorrelation, growth appeared larger than before. Such inconsistency may be due to hormonal metabolic disturbances in the mother’s body.

Topic 3. Causes and mechanisms of damage in rhinolalia

.Causes of rhinolalia.

See the shape of the native gorges.

Classification of rhinolalia.

The mechanism of mental disorders in rhinolalia.

Mechanisms of destruction of movable breath, voice production and sound production.

Etiology

The etiological causes of anomalies in the human body, crimson and facial region, are divided into exogenous and endogenous.

Before exogenous factors appear:

1) physical (mechanical and thermal injections; external and internal ionization);

2) chemical (hypoxia, inadequate nutrition of the mother during critical periods of embryo development, deficiency of vitamins (retinol, tocopherol acetate, thiamine, riboflavin, pyridoxine, cyanocobal amine), as well as essential amino acids and iodine in the mother; cause hypoxia in the fetus and lethargy in the new one, infusion of chemical agents that have an ionizing effect, for example, mustard;

H) biological (viruses of cow rubella, mumps, herpes zoster, bacteria and their toxins);

4) mental (call hyperadrenalemia).

Before endogenous factors lie down:

1).

2) biological inferiority of cells;

H) pouring in the century and article.

In the anamnesis of illnesses and their fathers, it is often possible to identify such factors that may lead to the appearance of congenital defects: a history of maternal illness, infectious disease; toxicosis, fleeting and artificial abortions; serious physical injury at 8-12 years of age; illness of the state sphere; severe mental trauma to the mother; late life canopies; mother's tavern destroyed.

See the shape of the native gorges

Before their birth, the heavens are as fragile as they come:

1) congenital gorge of the sky and lips

2) submucosal clefts;

3) born underdeveloped palate;

4) congenital asymmetry of the face due to deformation of the palate.

Most often in practice, the gaps in the lip and sky become narrower. The shapes of the sky gorges are extremely varied, but they lead to the destruction of the drainage.

Cleft lips. They separate the part and the other gorge lips. The anatomical structure and size of lips in children and adults varies significantly.

A normally folded upper lip contains the following anatomical components:

1) filter; 2) two columns; H) chervona oblyamivka; 4) middle hump; 5) line, or arc, of Cupid. This is the name of the line that separates the red edge and the skin of the upper lip.

When treating a child with a congenital defect of the lip, the surgeon is required to carry out a list of elements.

Classification. Based on the clinical and anatomical signs, congenital defects of the upper lip can be divided into a splint group.

1. The undeveloped upper lip is divided into sides - one-sided(which is close to 82%), bilateral.

2. on private(If the gap has expanded beyond the red border, or at the same time with the red border there is a gap in the lower section of the skin part of the lip

і povni– between the lips there are high lips, as a result of which the wing of the nose appears flared through the unbroken base of the nostril

Cracks of the sky. The palate is normal - due to light, as the empty mouth, nose and pharynx open. It consists of hard and soft palate. The brush base is solid. In front and on the sides it is framed by the alveolar process of the upper cleft with teeth, and behind by the palate. The hard palate is covered with a mucous membrane, the surface of which behind the alveoli has increased tactile sensitivity. The height and configuration of the solid palate influence the resonance.

The soft part of the palate is the posterior part of the septum between the sides of the nose and mouth. M'yak pіdabіnna represents m'yazovu light. The anterior third is practically indestructible, the middle third is the most active part in the movement, and the posterior third is the most active part in the tension and kovtanni. When the soft tissue rises, the palate will become soft. In this case, beware of thinning of the anterior third and thickening of the posterior third.

Since the palate is anatomically and functionally related to the cloth, the palatal-pharyngeal mechanism takes part in the breath, the cloth and the mouth.

When breathing, the palate is lowered and often covers the opening between the pharynx and mouth. When the soft tissue is pressed, the palate stretches, rises and approaches the back wall of the pharynx, which apparently collapses and comes into contact with the palate. At the same time, other muscles ripple: the tongue, the side walls of the pharynx, and the upper pharynx.

When blowing, hammering, or whistling, the palate rises even higher, lower during phonation, and closes the nasopharynx, which is how the hammer sounds.

Significant rhinolalia

This damage to the sound and timbre of the voice is a result of anatomical and physiological defects in the physical apparatus. It suffers from both voiced sounds (voiced and voiceless), and voiced sounds. It’s not just the production of sound that suffers, but the voice. The presence of a nasal tone in the voice suggests rhinolalia from dyslalia, which is characterized by impaired sound production.

Depending on the nature of the damaged movable apparatus, the nature of the anatomical defect and dysfunction of the hypopharyngeal joint, rhinolalia manifests itself in 3 types - open, closed and mixed. The etiology may be organic and functional.

The causes and mechanism of language impairment in rhinolalia: modern approaches.

The pathological features of the life and activity of the washing apparatus represent different effects in the development of the sonic side of the prom, and different structural components of the prom suffer in different ways.

The rumors indicate the impairment and abnormality of the mind in the course of prelinguistic development of children with rhinoplasty. In connection with the damaged speech periphery of the child, intense protein production and articulation “gray” are reduced, thereby strengthening the stage of preparatory adjustment of the movable apparatus.

Both the articulation of sounds and the development of prosodic elements of pronunciation suffer.

There is a late beginning of promotion, a significant hour interval between the appearance of the first warehouses, words and phrases is already at an early stage, so that the development of promotion begins. The greatest degree of defect manifests itself in the damaged phonetic side.

The most obvious manifestations of the defective phonetic design of language are the destruction of all oral sounds of language due to the connection of the nasal resonator and the change in the aerodynamic minds of phonation. The sounds become nasal.

This reveals a specific suppression of certain vocal sounds (usually posterior palatal ones) for the connection circuit of the pharyngeal resonator.

The signs of additional articulation in the empty larynx also become sharper, which gives rise to a kind of “clicking” sound.

There are no other major defects. For example: lowering the cob voice (“ak, am” - yes, there); neutralization of dental sounds according to the method of creation; replacing vibukhian sounds with fricatives; whistling sound with visible hissing sounds or inadvertently; Number of days of choice R or replacement with sound s with strong vision; applying additional noise to nasal sounds (hissing, whistling, gasping, croaking, larynx, etc.); movement of articulation in the posterior zone.

The language of the child with rhinoaliya zagalom is a little overbearing.

Thus, the mechanism of destruction during acute rhinolalia is indicated as follows:

1) due to the absence of the palatine-pharyngeal seal and as a result of its damage, assign sounds to the sign of the oronasal;

2) changing the place and method of articulation of most sounds through defects of the hard and soft palate, flakiness of the tip of the tongue, lips, insertion of the tongue deep into the mouth, high position of the root of the tongue, participation in articulation of the pharynx and larynx.

Features of the sheet. The peculiarities of language in children with rhinoalia lead to the development and immaturity of the phonemic system of language.

Suddenly, the peculiarities of the perception of natural sounds are understood and the main step is to complete the correct sheet.

The connection between sheet damage and defects in the articulation apparatus may have different manifestations. If, at the time of pregnancy, the child with rhinolia was suffering from a viral infection, but it is clearly possible to detect most of the sounds of a native language, and in this language the insignificant nasal tone is lost, then the development of sound analysis is necessary suitable for learning to read and write, it proceeds successfully. However, as only children with rhinoalia suffer from additional defects for normal brain development, specific handwriting impairments appear.

Dysgraphic expressions, which are avoided in writing robots of children with cleft palates, are different.

Specific for rhinolalia and replacement P, b on m, t, d on n and gate replacements n - d, t, m - b, p, the development of the phonological arrangement of similar sounds in language reveals omissions, substitutions, use of sticky voices, wider substitutions and a mixture of sibilant-whistles, difficulties in the use of African sounds, sound ts replaced by s, characterized by a mixture of voiced and voiceless voices, frequent excuses for skipping one letter in the run, sound l be replaced r, r on l.

The level of impairment of writing lies in low factors: the depth of the defect in the articulation apparatus, the particular characteristics and compensatory abilities of the child, the nature and terms of the speech therapy infusion, the infusion of the brain.

The zagal characteristics of rhinolalia.
Rhinolalia(from Greece nіs + mov) - destruction
timbre of voice and sound perception, based on anatomical and physiological
defects in the moving apparatus.
Rhinolalia behind its directives, it is determined by the presence of changes
nosalized (lat. nіs) timbre of voice.
With rhinolalia, the articulation of sounds and phonation are significantly different from the norm.
With normal phonation, under one hour, all language sounds, except nasal sounds, are lost in humans
There is a division of the nasopharyngeal and nasal emptying from the pharyngeal and oral.
These empty items are shared with the palatine-pharyngeal squeezes, which result in shortening of the meat.
palate, side and back walls of the pharynx.
At the same time, with the sound of a soft palate during phonation, thickening of the posterior wall of the pharynx occurs.
(Passavan roller), which adheres to the contact of the back surface of the soft
The palate from the posterior wall of the pharynx.
Under the hour of rinsing, the palate reliably lowers and rises to different heights without fail
the type of sounds that are heard and the tempo of the movie. The strength of the hypopharyngeal contraction lies in the
Sounds are heard. There is a mensch for those who speak loudly, and a lower one for those who speak loudly. Weaker
The palatopharyngeal contraction is avoided when appropriate V , strongest - at h ,
Sound 6-7 times stronger, lower at A. With normal voice, nasal sounds mm" ,n, n" abrasive stream
penetrates well into the expanse of the nasal resonator.
Depending on the nature of the dysfunction, the functions of the palatal-pharyngeal junction appear to vary
forms of rhinolalia. The presence of native palatal clefts is strongly reflected in every development of the child:
children are sick, somatically weakened, they often have decreased
hearing In case of rhinolalia, the defect of the tongue can be treated with drugs in the development
greater mental functions. These ailments are characterized by their
the development of particularities and the formation of activity.
The most common defect in the rhinolysis is believed to have a low number of causes.
Before we ensure the security of life, important functions of food and food are brought to
specific position of the body of the tongue (with a supra-raised root). Take
the formation of our people led to the destruction of their functional capabilities, from one
parties, as well as before defective compensation for damage - from another (under the hour of cleaning
articulation results in the formation of various forms of synkinesis).
In case of rhinolalia, the formation of an atypical specific disorder, development
hypernasolation and defects in the articulation of sounds.
The picture has a major damage to the conductors and a defective sound signal, otherwise it may
suffering in the lexico-grammatical way of the language, phonemic hearing, writing
language Correction of the defect is carried out through medical, speech therapy and psychological-pedagogical methods.
dii.