Pectus excavatum - also known as sunken chest syndrome - is the most common chest wall disorder treated at Nationwide Children’s. Pectus excavatum is a deformity that occurs in approximately one out of 1,000 children. It is characterized by a concavity of the sternum. The disorder is about five times more common in boys than girls and is usually noted at birth as a mild condition but can become progressively more pronounced over time.
Additional symptoms and conditions can include:
Chest wall deformities can be evident in infancy, but many also develop or become more obvious as children grow. Abnormalities are usually noted by the parents, but may be evident only to the physician and found during routine chest examination.
Other deformities may be noted by the patient. Because the chest wall develops over time, becoming less flexible after infancy, disorders may become more or less problematic with maturation of the chest wall.
For those who require treatment, the most commonly performed procedure is a minimally invasive thoracoscopic surgery to correct the deformity by placing a prosthetic bar behind the sternum, known as the Nuss procedure. The bar is removed after three years and the defect has remodeled into a more symmetrically positioned sternum. The appropriate timing of surgery is typically in the early adolescent years, but patients undergo evaluation for this condition at any age.
This minimally invasive surgery is a marked improvement over traditional open surgery for treatment of pectus excavatum, meaning several advantages to patients, including:
Patients who are looking to avoid surgery or who do not qualify for surgery have the option of choosing non-surgical treatment pairing vacuum bell therapy with exercises and stretches. Patients who choose this option typically see excellent results including:
The optimal ages for chest wall deformity referrals are between 10 and 12 years. Patients are examined earlier if parents or the primary care physician have questions.
If patients are diagnosed after adolescence, they can still be examined to determine what their options are given the severity of the deformity. With any of these referrals, no pre-visit studies are needed.