Pectus excavatum — also known as “sunken chest” or “funnel chest” — occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6% of 7- to 14-year-old children.
Most kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. Though it is typically a standalone condition, up to 20% of patients might have additional skeletal conditions, such as scoliosis.
Depending on its severity, pectus excavatum might cause your child to experience chest discomfort, shortness of breath, decreased physical stamina and endurance, and heart palpitations, especially during exercise. It could also cause your child to feel self-conscious or anxious about their appearance.
Pectus Excavatum Diagnosis and Treatment
Because of its visual nature, pectus excavatum can usually be diagnosed during a physical examination. To determine the severity of the condition, your medical team will order a series of tests, including an echocardiogram, pulmonary function test, cardiopulmonary exercise testing, and CT scan or MRI of the chest.
Nonsurgical Treatment
Initial care might include monitoring your child’s growth and chest-specific physical therapy. Our team will provide you with a list of chest wall and arm exercises that are helpful in reshaping the chest and strengthening the muscle groups involved. However, over time, surgical correction is frequently recommended.
In less severe cases, we offer a nonsurgical treatment called the “vacuum bell.” This is essentially a large suction cup that creates a vacuum seal on your child’s chest wall and lifts the sternum, correcting pectus excavatum over time. The vacuum bell does not interfere with daily activities, such as school and sports. This approach works best for younger patients with less severe malformations and a soft pliable chest. However, 25% of patients will have a recurrence and need additional treatment.
Surgical Treatment
We perform two different types of surgery, and the decision about which procedure to perform is based on several factors that are specific to each patient.
The Nuss Procedure
In most cases, we perform a minimally invasive surgery called the Nuss procedure, where we make small incisions on both sides of the chest wall and using a camera insert one or more custom-fitted titanium bars behind the sternum. The bar(s) would remain in place for two to three years and then be removed during a minor outpatient surgery. Patients are left with small scars after completing this treatment.
Modified Ravitch Procedure
If the Nuss procedure isn’t appropriate, a surgery called the modified Ravitch procedure is used. Instead of small incisions, we would make one incision in your child’s chest wall, remove abnormal cartilage, place the sternum in an appropriate position and, in rare occasions, insert one or more steel bars to support and elevate the area as it heals. If we insert bars, they would be removed on a later date. The modified Ravitch procedure is especially well suited for patients who do not wish to have a bar in place for more than one year and those with highly asymmetric chest wall deformities or problematic lower rib flaring.
Both of these procedures are performed while your child is under general anesthesia.
Pain Control
Our team utilizes an innovative approach to post-operative pain relief using cryoablation. During this procedure, a probe is inserted into the chest using small incisions and temporarily freezes the nerves. Minimal numbness in the chest wall may last up to six months.
When your child is awake in the recovery room, our nursing team and anesthesiologist work together to ensure he or she is as comfortable as possible. Your child will receive a combination of intravenous (IV) and oral pain medications, muscle relaxants and local anesthetic patches after surgery. We use minimal narcotic pain medications.
Using these innovative approaches, the average hospital length of stay is usually 2-3 days.
Once your child is ready to go home, the IV pain medications are stopped and he or she is transitioned to over-the-counter pain medications. Some children may require up to one week of these medications after they are discharged.
