Congenital chest wall deformities are generally categorized into five groups: pectus excavatum or funnel chest, pectus carinatum or pigeon breast, Poland syndrome, sternal defects, and mixed dysplasias or those due to diffuse skeletal disorders such as Marfan syndrome. In addition, there are less common but often fatal thoracic malformations such as thoracic transposition of the heart and asphyxiating thoracic dysplasia (e.g., Jeune syndrome). Funnel chest: funnel chest (pectus excavatum or funnel chest) is the most common chest wall deformity, accounting for more than 90% of all chest wall deformities, with an incidence of 1 to 4 per thousand, and up to 8 per thousand has been reported, with males being more frequent than females, at a ratio of about 4:1. The presence of the deformity can be detected within one year of birth in 90% of the patients, with a small number of patients presenting after one year of age. Funnel chest deformity. The deformity usually worsens as the patient grows, to the point where the back of the sternum is close to the anterior margin of the vertebrae. Pathologic funnel chest deformity is often the result of the fourth through eighth rib cartilages being concave from the medial or lateral rib-cartilage junction toward the spine, forming the lateral walls of the funnel, with the sunken sternum forming the lowest point of the funnel. Funnel chest deformity in young children is often symmetrical, with age may appear asymmetric and accompanied by rotation of the sternum, part of the scoliosis. It is estimated that about 10% of patients with funnel chest have concomitant scoliosis, while about 2% have concomitant congenital heart disease. The initial lesion of funnel chest is deformity of the chest wall, but with the aggravation of the deformity, the respiratory and circulatory functions can be affected, and at the same time, due to the deformity of the chest, the patient appears to have a change in personality. To evaluate the severity of funnel chest, the thoracic index is often used, i.e., the ratio of the maximum transverse diameter of the inner surface of the thorax measured at the lowest point of the sternal depression and the shortest distance between the posterior edge of the sternum and the anterior edge of the corresponding vertebrae, and the value of which is greater than 3.25, which is considered to be moderately severe and requires surgical treatment. The thoracic index can usually be calculated with chest X-ray posterior anterior and lateral films, and is more accurately measured with chest CT films. Clinical manifestations and diagnosis The clinical manifestations of funnel chest vary with the degree of deformity, but the basic manifestation is a funnel-shaped deformity of the anterior chest wall. The lesser degree has no cardiopulmonary function damage and often has no other symptoms, but with the aggravation of the degree of deformity, it presents the typical signs of funnel chest, such as two shoulders tilted forward, back bowed, forehead sunken, and abdomen bulging. The patient’s heart is compressed, and symptoms of respiratory and circulatory system appear, manifesting as palpitation, shortness of breath after activity, pain in the precordial region, decreased lung capacity, increased residual air volume, and recurrent respiratory infections. The affected children like to be quiet but are not good at moving, and older children are unwilling to participate in sports activities due to thoracic deformity, and have psychological disorders due to introversion and even mental depression. Chest X-ray of moderate to severe funnel chest shows that the heart is shifted to the left side of the chest cavity, cardiovascular angiography shows that there is a sternal indentation on the anterior wall of the right ventricle, and ultrasonography shows that the contact area between the myocardium and the anterior chest wall increases, and mitral valve prolapse can occur in some patients, and a functional heart murmur can be heard in the anterior region of the heart. Pulmonary atelectasis has been reported in about 25% of patients with funnel chest, predominantly in the upper lobe of the left lung. However, the effect of surgery on the lung function of funnel chest has been controversial. Those with severe preoperative lung function impairment can obtain different degrees of improvement after surgery, while those with mild preoperative impairment sometimes become worse after surgery, whether it is due to the poor development of the lung tissue itself or due to the restriction of lung expansion caused by thoracic deformity is not clear. According to the typical chest funnel-shaped deformity, the diagnosis of funnel chest can be made clearly, and the degree of deformity can be evaluated objectively by chest X-ray and CT scan, which is also valuable for the selection of surgical methods and estimation of the scope of surgery, and ultrasonography and pulmonary function test can understand the patient’s cardiorespiratory function status before surgery. In chest CT films of funnel chest, the anterior chest wall is seen to be concave and asymmetric, and the heart shadow is shifted to the left side of the chest cavity. Usually the chest index can be calculated with chest X-ray posterior anterior and lateral films, and measured more accurately with chest CT films. That is, the ratio of the maximum transverse diameter of the inner surface of the thorax and the shortest distance between the posterior edge of the sternum and the anterior edge of the corresponding vertebrae is measured at the lowest point of the sternal subluxation, and a value greater than 3.25 is considered to be moderately severe, and is one of the pointers for the need for surgical treatment. Treatment Meyer (1911) and Sauerbruch (1920), etc. began to introduce the surgical treatment of funnel chest, Ravitch surgery in 1949, namely, the sternotomy of the sternum uplift and later continued to improve, and its applicability to all patients with funnel chest of different ages, so that the operation was widely used worldwide until the 1990s, and has become the classic procedure for the treatment of the funnel chest orthopedics, and the Sternotomy is less used due to its more invasive nature. There have been cases of subcutaneous gap filling with silicone gel orthopedics for those with milder funnel chest deformities, which had no effect on increasing thoracic volume and was not popularized. In 1997, Nuss, an American pediatric surgeon, introduced a kind of funnel chest orthopedic surgery by placing a curved steel plate from the back of the sternum to lift up the sunken anterior chest wall without any osteotomy, and the immediate orthopedic effect of the surgery was obvious. The procedure is minimally invasive and beautiful, no scar on the anterior chest wall, and completely changed the traditional concept of surgical treatment of funnel chest, by the United States pediatric surgical community’s attention and gradually be applied, is now widely carried out, after 2000, also gradually introduced in China to promote the domestic, and after continuous improvement to summarize the experience, and has become the mainstream of the surgery for the treatment of funnel chest, the early complications that may occur in this surgery are also gradually reduced, reduced, and the improvement effect is obvious. Some of the complications that may occur in the early stage of this surgery have also been gradually reduced and minimized, and the improvement effect is obvious. Minimally invasive is the development trend of funnel chest correction. As NUSS surgery for funnel chest has the advantages of minimally invasive and aesthetic, its use is being further promoted with the advancement of technology and improvement of living standard. Chicken chest (pectus carinatum): generally a disease related to calcium and phosphorus metabolism disorders, there are very few congenital or secondary to thoracic surgery of the latter, the majority of cases is the body of the sternum and the lower rib cartilage connected to the symmetrical protruding forward, a small number of asymmetric deformity of unilateral convexity, a small number of cases of mixed deformity, one side of the convexity and the other side of the concave or the upper section of the chicken breast and the lower end of the funnel chest changes, but the sternum and the lower end is a chicken chest. The upper part is chicken chest and the lower part is funnel chest, but it is rare that the sternal handle and the rib cartilage connected to it are anteriorly convex while the sternal body is sunken. The effects of chicken breast on cardiorespiratory function are minor, but more severe deformities may result in personality and social behavioral changes due to the deformed chest. Except for the appearance of the deformed chest wall, most patients do not have other manifestations, but as the patient’s physical development and the degree of chest wall deformity gradually aggravate, the very serious cases can also lead to the relative reduction of chest cavity volume, cardiopulmonary compression and the clinical manifestations of cardiopulmonary insufficiency. A few patients often experience localized pain due to trauma to the anteriorly protruding chest. Patients with more serious chicken chest or mixed deformity are often reluctant to participate in sports activities, especially unwilling to take off their shirts in front of other people, and some patients will become introverted or even develop psychological disorders as a result. The diagnosis of chicken chest can be made according to the special signs of deformed chest, but chest X-ray and CT scan and cardiopulmonary function test should be carried out to evaluate the degree of deformity and the status of cardiopulmonary function, which can also be used as a reference for estimating the scope of surgery. The age and indications of surgery for chicken chest are tightly controlled, lighter and symmetrical deformity can be corrected by physical exercise, usually patients with heavier deformity above 10 years old are considered for surgical treatment, in the past, Ravitch surgery was used for the treatment of chicken chest, but recently, minimally invasive methods similar to Nuss surgery have been started to be applied in the clinic for the correction of chicken chest, which has shown good results in the near future, with less trauma and more beautiful chest after correction. The use of this procedure is gradually increasing. Poland syndrome Poland syndrome Several conditions of rib development and chest manifestations: Percentage of manifestations (%) Normal chest wall appearance 54.7 Rib hypoplasia without chest wall subsidence 13.3 Chest wall subsidence 21.3 Missing ribs 10.7 Indications for treatment Surgical indications: missing ribs; severe chest wall subsidence Surgical modalities: latissimus dorsi muscle transfer, patching, latissimus dorsi muscle transfer with patching, tissue engineering; Females may have the chest wall reconstructed with the latissimus dorsi muscle or other tissue. Sternal defects are much less common and require surgical repair of the defective sternum to protect the heart and other organs in the chest from injury.