Pectus excavatum, also called funnel chest, is the most common congenital deformity of the front wall of the chest. This abnormal formation of the rib cage develops during pregnancy and gives the chest a caved-in or sunken appearance. Researchers believe the cause is abnormal growth of the connective tissue that connects the ribs to the breastbone.
A child with pectus excavatum usually has a depression in the center of the chest over the breastbone, which may appear quite deep. Severe cases of pectus excavatum may affect the function of the heart and lungs, in addition to creating psychological difficulty for the child.
Pectus excavatum is often diagnosed by the patient or their family members who notice an abnormal shape of the chest. This can occur as small children or develop later in life, especially during the prepubescent years, when kids go through their growth spurt. Pectus excavatum may occur with or without a family history.
The majority of pectus excavatum cases are not associated with other conditions. However, tests may be done to rule out other suspected disorders, including Marfan syndrome, a connective tissue disorder that causes long limbs, curvature of the spine and chest abnormalities; Poland syndrome, a disorder marked by missing or abnormal muscle development on one side of the chest and abnormalities of the hand; scoliosis or curvature of the spine; or rickets, which results from a lack of vitamin D or calcium and not enough exposure to sunlight, which interferes with normal bone growth. These tests may include chromosome and metabolic studies, enzyme assays and x-rays.
Your doctor may recommend physical therapy for your child to slow or reverse the effects of pectus excavatum. However, surgery is generally advised for severe pectus excavatum that gets in the way of exercise and daily activities. Some patients and parents make the decision to have surgery based on the physical appearance. Severe pectus deformities can have a severe impact on the child’s social development and self-esteem.
Surgery for pectus excavatum is typically performed when children are between 10 and 14 years of age. The primary goal of surgery is to correct the deformity, improve posture and lung and heart function. The Nuss procedure, using the metal Nuss bar, is a minimally invasive approach used in greater than 90% of pectus excavatum operations in the United States.
The surgery involves removing a portion of the deformed cartilage and repositioning the breastbone. Most operations for pectus excavatum are performed by inserting a metal bar under the breastbone. In certain situations, the pectus deformity requires an open operation to remove the abnormal cartilage that connects the ribs to the breastbone.
During the Nuss procedure, patients undergo an extensive pre-surgery workup to understand the severity of the deformity and identify any additional problems. The operation is performed with small incisions along the chest using a specialized camera.
To speed recovery and improve pain management, the affiliated pediatric surgeons use Cryoanalgesia. This technique blocks the pain impulses to the brain by freezing the nerves, allowing patients to feel little pain after surgery. Most patients require a 2-5 day hospital stay. Full recovery may require several weeks and close follow-up is maintained until the Nuss bar is removed, after approximately 3 years.
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