Chest wall Deformities cause the chest to develop abnormally and deteriorate the physical appearance. In addition, deformity in the chest can lead to loss of function in the lungs. Therefore, eliminating these deformities is essential for the patient's recovery.
What Are the Types of Chest Wall Deformities?
There are many types of congenital chest wall deformities. Pectus excavatum (shoemaker's chest) and pectus carinatum (pigeon's chest) are the most common conditions. The shoemaker's chest is slightly more visible than the pigeon's breast. Other deformities include Jeune syndrome, pectus arcuatum, and rib and sternum disorders.
Shoemaker's Chest: This disease, known as shoemaker's chest, is called pectus excavatum in medical language. This problem, which causes the chest to appear sunken or hollow, is a congenital deformity and often develops in children.
Shoemaker's chest of unknown cause usually develops in people with a positive family history. In addition, the incidence in men is 3 to 5 times higher than in women. Shoemaker's chest can be caused by connective tissue problems such as kyphosis, Marfan syndrome, scoliosis, and the deformity usually becomes evident in childhood. It becomes more severe over time.
Symptoms in children with shoestring chest include shortness of breath, chest pain, and fatigue. In some children the disease is asymptomatic.
Pigeon Chest: It is a disease that occurs with abnormal and disproportionate growth in the cartilage that connects the ribs to the sternum, known as pectus carinatum in medical language. As a result, the sternum protrudes, and the chest wall develops curved instead of straight. Pigeon chest, which is less common than the shoemaker's chest, may occur due to scoliosis, heart disease, kyphosis, musculoskeletal system defects. As a result, one side of the trunk becomes more extensive than the other, and chest asymmetry occurs.
The pigeon chest's exact cause is unknown, and family history is essential in individuals affected by the disease. It occurs more frequently in men than women, and the symptoms may present at an advanced age compared with the shoemaker's chest. As the child grows, complaints and symptoms increase. The most common complaints are shortness of breath, chest pain, and fatigue.
Diagnostic Methods in Chest Wall Deformities
The family notices congenital chest wall deformities in children before one year old. In the beginning, complaints in children are usually limited to shortness of breath and chest pain, and they progress with age. Some patients are asymptomatic until adulthood. In elderly patients, complaints such as pain in the anterior chest wall and heart palpitations are common.
These diseases, with abnormal inward or outward development of the chest wall, become visible in size. In addition to imaging techniques such as chest radiography and computed tomography for a precise diagnosis, we should do ECHO, ECG, and breathing tests.
Treatment of Chest Wall Deformities
Each disease has different surgical treatment methods. Surgical operations are decided by considering the extent of the disease and the general health of the patient and can be performed with open or closed methods.
While open surgeries are common, closed surgeries result in fewer scars and hospital stays. We can also apply non-surgical treatment methods to some patients.
Shoemaker's Chest Treatment
We can perform various non-surgical procedures on the shoemaker's chest with the non-surgical vacuum bell method. This situation is not life-threatening for the patient, and the surgical operation is optional. Operations for repairing and restructuring the chest wall are performed after adolescence. By this time, the patient's growth phase is over, and the success rate of the surgery increases. The deformity may recur even after surgery; therefore, we avoid surgery in young children.
The Ravitch procedure and Nuss application are two different types of surgery that are preferred. Both approaches are performed under general anesthesia and require approximately one week of hospitalization.
The patient's age and health condition affect the preferred method. The Ravitch operation is an open repair and involves bringing the patient's chest to its normal position with an incision made in the middle of the chest. The Nuss operation is performed by placing a stainless bar on the chest wall; it is fixed with an incision under the arm accompanied by an endoscope. It keeps the chest wall in its normal position.
The Vacuum Bell method is non-surgical. In this method, a vacuum device completes the procedure by pushing the rib cage forward.
Pigeon Breast Treatment
Treatment involves stretching the chest wall. To stretch or straighten the chest wall, a corset that exerts force on the rib cage must be worn. Brace treatment is preferred in children with deformities and generally gives excellent results until puberty.
However, doctor's advice is essential during the use of the corset. We generally recommend wearing it day and night for up to 1 year. In some patients, corset treatment may take a few months, while in some patients it may take more than a year. Therefore, the treatment process differs from patient to patient.
Infants often recover sooner than young children, but the disease may recur during adolescence. In this case, a surgical procedure is necessary.
Surgery is unnecessary for every patient, but it is preferred in cases where corset treatment is insufficient. The operation is completed by making a horizontal incision in the middle of the chest, removing the abnormal cartilage, and pushing the sternum down, which takes a few hours.
In some patients, occasional sternum fractures are unavoidable during the procedure; afterward, metal chest support is essential. In such patients, the duration, method, and preference of surgery vary depending on the patient's age and disease progression.
In summary, there are different treatment methods for congenital chest deformities. It is necessary to consult a specialist physician for the most appropriate treatment.