Sunken Chest and Pigeon Chest
Pectus and Chest Wall Deformities
Sunken Chest and Pigeon Chest
As a parent, you might be concerned if you notice unusual shapes in your child's chest.
The two most common types of chest wall deformities are known as pectus excavatum, or sunken chest, and pectus carinatum, commonly referred to as pigeon chest.
These conditions occur due to abnormal growth of the ribs, sternum, cartilage, and the pectoralis muscles, leading to either a noticeable indent or protrusion in the chest area.
Understanding these congenital conditions is the first step, as treatment can vary depending on the specific diagnosis.
Early and timely intervention can significantly improve long-term outcomes, helping your child lead a healthy and active life.
What is the Chest Wall?
The chest wall is the protective frame around the upper part of the body. It includes the ribs, backbone, and breastbone, where the muscles and tissues hold everything together.
This structure, known as the thoracic cavity, protects the lungs, heart, and other essential parts that help us breathe and circulate blood.
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Pectus Carinatum: Pigeon Chest Syndrome
Pigeon chest is a deformity that causes the chest to protrude at the breastbone, ribs, and cartilage.
The breastbone and ribs bulge from the chest, creating a bowed deformity of the chest wall. The bulge is usually asymmetric and affects the lower sternum and ribs. In rare defects, the protrusion is limited to the uppermost portion of the sternum.
Pectus Carinatum Brace for Treatment
Bracing is usually effective in correcting pectus carinatum in children by applying external pressure.
Children's chests can be shaped over time because they are more supple. However, some children with pectus carinatum need surgery to correct the problem.
External compression devices apply continuous pressure to reshape the chest wall over time, specifically targeting protruding regions.
Various devices are available that are well-tolerated, low-cost, and easy to wear at night and during the day. Measurements are taken during your consultation to determine the best fit of the brace.
Patients are seen regularly for adjustments, and the length of time for treatment varies based on the severity of the abnormality and adherence to wearing the brace.
Pectus Excavatum: Sunken Chest Syndrome
A sunken chest, or pectus excavatum, is a deformity when the breastbone and rib cage sink into the chest, creating a caved-in chest wall deformity.
Pectus excavatum can cause the front of the rib cage to sink inwards and cause rib flaring.
Pectus Excavatum Treatment
The Nuss procedure is a minimally invasive operation. The surgeon inserts one or more curved metal bars under the chest wall.
These bars are placed behind the breastbone and push the sunken chest outward, creating a more normal chest shape. The bars are usually left in place for several years to maintain the new shape of the chest as it heals and stabilizes.
The operation is known for its high success rate and low risk of complications, including bleeding, infection, bar migration, and cardiac puncture. Patients who undergo this procedure report high levels of satisfaction.
The procedure is minimally invasive compared to older methods, meaning it involves smaller incisions and generally less pain and recovery time for the patient.
It's often performed on children and teenagers because their bones are still growing and can adapt more quickly to the change in shape.
The Nuss procedure improves the appearance of the chest and enhances the patient's breathing and overall heart and lung function. A sunken chest can sometimes press on the heart and lungs, making breathing and circulation more difficult.
Mixed Chest Wall Deformity
A mixed deformity of the chest, involving both pigeon chest and sunken chest, is a condition where the chest wall has protruding and indented areas.
In cases of mixed deformity, the chest wall doesn't have a uniform shape, leading to complex visual and potential health impacts.
This can affect the lungs and heart, possibly impacting breathing and circulation. The mixed nature of the deformity means that different parts of the chest may push outward or inward, which can complicate both diagnosis and treatment.
Treatment for a mixed chest wall deformity often requires a tailored approach, as the surgeon must address both the protruding and indented aspects of the chest wall.
This might involve a combination of surgical techniques designed to correct each aspect of the deformity, ensuring that the chest wall can support normal respiratory function and provide protection for the heart and lungs.
Returning to Activities After Surgery
Surgery to correct the shape of the chest wall can be painful. Fortunately, researchers have made advances in controlling pain.
Enhanced Recovery After Surgery (ERAS) protocols help our patients experience less pain, recover more quickly, and return home faster.
After surgery, your child cannot participate in sporting events, weightlifting, aerobic exercise, or physical education for at least six weeks.
These limitations allow your child's bars to stabilize in the chest. After six weeks, your surgeon will go through a patient-specific plan for your gradual return to your regular activities. Most patients can return to contact sports three months after surgery.