1. What is funnel chest?
Pediatric funnel chest is the most common congenital chest wall deformity (90%), the ratio of male to female is 4:1, it is a funnel-like chest wall deformity caused by the lower sternum and rib cartilage subsidence, the most common is the third rib cartilage to the seventh rib cartilage to deep depression deformation, the rib bone of this part, the rib cartilage combination of the medial or lateral bend towards the spine to form the two sides of the wall, although the tip of the saber process up, the whole saber process down, constituting the funnel The lowest point.
2. What is the incidence of funnel chest?
There is 1 case for every 300-400 children born.
3. What is the cause of the disease?
The etiology of this disease is still not completely clear, but in recent years some studies have found that
1 ） Shortening of the central tendon of the diaphragm: Although the change of doctrine can visually explain the formation of funnel chest, the shortened central tendon was not found during surgery, and the imaging findings do not support it and are not consistent with the clinical presentation, so the proponents of this doctrine are rapidly decreasing.
2) Airway obstruction: If there is an obstruction of the airway, a funnel chest can form over a long period of time due to inspiratory dyspnea and forceful inspiration. However, most children with respiratory obstruction do not develop funnel chest, and children with funnel chest do not necessarily have respiratory obstruction, which indicates that respiratory obstruction is only a causative factor in the formation of funnel chest.
3 ） Partial anterior diaphragm muscle fibrosis: proposed by Brodkin in 1953, but it cannot explain some clinical manifestations and is only a partial cause for the formation of funnel chest.
4 ) Bone and rib cartilage dysplasia: Although no direct evidence of rib cartilage and sternum dysplasia in children with funnel chest has been obtained, abnormal biochemical tests of rib cartilage have been found, with abnormalities observed under light microscopy and mutations in the amino acid sequence of cartilage collagen. It has also been found that rib cartilage in children with funnel chest has reduced zinc content and increased calcium and magnesium content; that rib cartilage in children with funnel chest has reduced resistance to tension, stress, and bending; and that type II collagen has a disordered morphology.
5) Connective tissue abnormalities: Since funnel chest is often combined with diseases of the skeletal muscular system, especially the recent discovery of abnormal collagen synthesis in skin fibroblasts of children with funnel chest suggests the possibility of systemic connective tissue diseases in children with funnel chest.
(6) There is a genetic factor for funnel chest: 11%~37% of children have a family history. Funnel chest is associated with decreased immune function. The argument that funnel chest is caused by rickets is not valid. 4.
4. Is funnel chest hereditary?
There is a certain tendency of heredity, and according to the research study, 37% of the affected children have a genetic predisposition.
5. Can funnel chest heal on its own?
It is possible for individual children to heal on their own.
6. Does the disease worsen progressively?
Most children have a typical presentation at birth, and 90% of them are diagnosed within 1 year of age. The disease is mostly stable at the beginning, but in early adolescence, when the skeleton is developing rapidly, the disease rapidly worsens progressively, with deepening of the depression and rotation of the sternum, mostly to the right.
7. What is the effect of funnel chest on heart and lung function?
In most cases, the sunken sternum has no significant effect on cardiopulmonary function. Most children with the condition have a slightly lower lung volume than normal children, but it is still within the normal range; however, the pumping function of the heart decreases during strenuous activity, and according to statistics, the survival age of patients with funnel chest is 40-50 years. After surgery, it returns to normal.
8. What are the main symptoms of funnel chest?
The main symptoms of funnel chest are divided into 4 major types.
1) Pain.
2) symptoms appearing from compression of the heart and lungs, such as shortness of breath and palpitations after activity
3) chest wall deformity.
4) psychological disorders and mental abnormalities.
9. What are the diseases that need to be differentiated from funnel chest?
Funnel chest needs to be differentiated from Marfan syndrome, rickets and scoliosis.
10. What is the best age for surgery for funnel chest?
The optimal age for surgery is 4 to 12 years; most surgeries after the age of 12 years require placement of two Pectus bars and 3 to 5 years.
11. What are the indications for surgery of funnel chest?
1) Moderate or severe funnel chest deformity with depression depth > 2 cm or hydrolysis volume > 20 ml or funnel index (F2 I) > 0.12; Haller index > 3.25 on CT.
2) Pulmonary function suggests restrictive or obstructive airway pathology, susceptibility to upper respiratory tract infections, reduced tolerance for strenuous activity, and shortness of breath when running or climbing stairs.
3） Heart pressure displacement, electrocardiogram shows myocardial damage.
4) Psychological disorders or mental abnormalities.
5) Strong cosmetic requirements.
12. Is there any non-surgical treatment?
There is no ideal non-surgical method, but preoperative exercise, especially chest expansion, and its external orthopedic support can reduce the symptoms and slow down the progression of the disease.
13. What are the surgical methods?
The traditional surgical methods include sternal reversal, sternal supination, etc. However, these traditional surgeries for chest wall deformities require four to six hours and bleed a lot because of the large surgical wound and the destruction of muscle and cartilage. The minimally invasive surgery developed by Dr. Donald Nuss of Daughter, Virginia, USA, has replaced the traditional surgery. This minimally invasive surgery involves the thoracoscopic guidance of a custom-made metal plate (Pectus Bar), which pushes the sternal depressions outward to correct the surgery and all the inwardly deformed rib cartilage is pushed outward with the metal plate, but no ribs are removed and there is no incision of the pectoralis major muscle. The metal plate is left in place for at least 2 to 5 years before being removed. The Nuss procedure takes only one to two hours, with minimal wounding, minimal bleeding, and preservation of muscle and cartilage, as well as a much shorter hospital stay. In addition to improving cardiopulmonary function, it can also correct the position of the sternum and rib cage and take into account aesthetic concerns.
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