Chest Wall Deformities
Our pediatric surgical team offers comprehensive, patient- and family-centered care for children with chest wall deformities. Over the last 30 years, our surgeons have treated children with the two most common conditions:
- Pectus excavatum (sunken chest)
- Pectus carinatum (pigeon chest)
We have experience treating rare conditions as well, such as mixed chest wall deformities and congenital and acquired thoracic dystrophy, like Jeune’s syndrome. In addition, we are one of the few hospitals in South Florida to offer a multidisciplinary clinic for chest wall deformities, where patients can see a physical therapist and surgeon in one place.
What is pectus excavatum?
Also known as sunken chest, pectus excavatum is a genetic condition caused by the rib cage and sternum growing abnormally, resulting in a concaved chest. While a baby may be born with the condition, this type of chest deformity typically becomes more severe during puberty because of rapid bone growth. Pectus excavatum is the most common form of congenital chest wall deformity and occurs more often in boys, however girls may be under diagnosed so it’s important that they’re checked for the condition as well. Studies have also shown it may be linked to Marfan syndrome - a genetic disorder of the connective tissue - and similar disorders.
What are the symptoms of pectus excavatum?
Depending on the severity of the condition, symptoms may include chest pain and shortness of breath or feeling tired after vigorous physical activity and distress caused by changing body.
How we treat pectus excavatum
In moderate to severe cases, non-surgical and surgical treatment options are recommended because the appearance of the chest may lead to children experiencing psychosocial problems, like depression, low self-esteem and poor body image. In addition, if a child participates in exercise or sports, their endurance may be impaired due to effects on the heart and lungs.
- Nuss procedure: Minimally invasive, elective surgery that temporarily places a curved metal bar underneath the sternum for up to four years. Recovery time is generally one month, so parents should consider scheduling surgery during the summer months.
- Vacuum Bell treatment: Non-surgical treatment where the patient uses a hand pump attached to a suction cup to create a seal on the chest to lift the sternum for up to 30 minutes, twice a day, for up to 15 months. Children over the age of four can also undergo this procedure.
- Ravitch technique: Normally reserved for severe cases in older patients, an open surgery that creates an incision along the chest to remove the cartilage and detach the sternum for up to six months.
What is pectus carinatum?
Otherwise known as pigeon chest, pectus carinatum is a genetic condition caused by the overgrowth of cartilage forcing the sternum and ribs to protrude. While it is less common than pectus excavatum, newborns may also have the condition, however, it generally becomes more pronounced during puberty and occurs more frequently in boys as well. Based on research studies, pectus carinatum may also be associated with other genetic disorders, including Marfan syndrome, Turner syndrome, Noonan syndrome, heart disease and scoliosis.
What are the symptoms of pectus carinatum?
While the heart and lungs develop normally in mild cases, the organs may not function optimally in moderate and severe cases. This can result in children having low energy and shortness of breath during strenuous physical activity.
How we treat pectus carinatum
In moderate to severe cases, a compression brace is used to correct the deformity by flattening the chest wall. This is a non-surgical procedure that uses precise pressure to reshape the chest without causing the child major discomfort or skin breakdown. Depending on the severity of the condition, the brace must be worn for up to 24 hours a day for up to 15 months.,
There are several types of braces used for pectus carinatum. Joe DiMaggio Children's Hospital is one of the few (and the first facility in Florida) using the FMF dynamic compression brace that is manufactured in Argentina.