Etiology Funnel chest is a congenital thoracic deformity in which the lower middle part of the sternum and the adjacent rib cartilage are sunken backwards, resembling a funnel. Funnel chest is the most common congenital thoracic deformity with an incidence of 2 to 4 per 1,000. Its etiology is not well understood, and some patients have a family history, which is currently believed to be unrelated to calcium deficiency and may be due to unbalanced development of the lower thoracic sternum, rib cartilage and ribs, and compensatory backward displacement of the sternum. The funnel chest with mild symptoms can have no obvious symptoms, while the funnel chest with moderate degree or more can affect the normal development of heart and lungs because the sunken sternum squeezes the important organs in the chest cavity, and young children often have repeated whistling infections due to obstruction of the whistling tract. As children grow older, the sunken sternum also affects cardiopulmonary function, resulting in decreased ventricular blood displacement and reduced lung capacity, which significantly reduces activity tolerance compared to normal children of the same age, and even presents symptoms such as dyspnea, palpitations, and even precordial pain after activity, and some children also develop arrhythmias and systolic murmurs. Some children also have congenital heart disease, pulmonary hypoplasia, Marfan syndrome, asthma, etc. The appearance of the anterior thoracic deformity also causes great psychological stress to the child, which may lead to isolation or psychological disorders. Diagnosis Funnel chest is diagnosed clinically at a glance, but to determine the severity of funnel chest relies on CT chest examination. Thoracic CT can more clearly show the severity of the thoracic deformity and the degree of cardiac compression and displacement. We used the Haller
The average thoracic index is 2.25 in normal subjects, <3.2 in mild cases, and >3.5 in severe cases. children with a thoracic index >3.25 generally require surgery. Treatment At present, for mild funnel chest, calcium supplementation, appropriate exposure to sunlight to increase the absorption of calcium, and supplemented with thoracic expansion exercises, such as chest expansion exercises, push-ups, etc.; for moderate to severe funnel chest, the treatment can only be corrected by surgery, and the patient’s age is generally required to be over 3 years old, our department carries out both traditional NUSS surgery and “ultra-minimally invasive funnel chest orthopedic surgery In our department, we perform both traditional NUSS surgery and “minimally invasive funnel chest orthopedic surgery”, which involves making 2-3 small holes of 1 to 2 cm in the chest wall without cutting off the sternum and ribs, and placing an orthopedic plate behind the sunken sternum to lift the sternum. Ultra-minimally invasive funnel chest orthopedic surgery is less traumatic to the patient compared to traditional NUSS surgery and does not restrict the growth and development of the child, guiding the future trend of funnel chest treatment (see my article “Ultra-minimally invasive funnel chest orthopedic surgery” for more details). Indications for surgery At present, the indications for minimally invasive funnel chest surgery include the following: (1) moderate or severe funnel chest with thoracic index >3.25; (2) progressive worsening of thoracic deformity; (3) contradictory chest wall movement during deep inspiration; (4) patients with obvious symptoms, such as palpitations, chest pain, and decreased activity endurance; (5) chest wall deformity that is unacceptable to patients and parents and affects the psychological development of the child; (6) patients who have failed or recurred after conventional surgery patients with funnel chest.