How is funnel chest treated?

  Funnel chest is a congenital chest wall deformity in children. It has been treated surgically in isolated cases in the 1920s. However, it is only in recent years that treatment has been considered from orthopedic, psychological and physiological aspects.  Funnel chest is an inferior sternal concave deformity. The sternal body starts from the lower edge of the sternal stalk and tilts backward to the upper part of the glabella to reach the lowest point, and the ribs on both sides then sink to form a funnel. The sunken sternum makes the child form a special body shape, which is called funnel chest body shape. That is: two shoulders leaning forward, sunken sternum, arching back, and bulging abdomen. The cause of the funnel chest is unknown, some believe that the central tendon of the diaphragm is too short and the diaphragm fibers are attached to the lower end of the sternal body and the saber process in front, pulling it. It is also believed that the rib cartilage is too long and squeezes the sternum backward. The disease can be detected in newborns and gets progressively worse with age.  According to whether the sternum is rotated or not, the funnel chest is divided into symmetrical and asymmetrical types, and according to the size and depth of the upper opening, it is divided into extensive, limited, common, and mixed types. The children with this disease are thin, like to be quiet but not active, some seem to be more active but can’t last, have reduced exercise tolerance, have a higher lung capacity than normal children, are prone to recurrent respiratory infections, have tachycardia or arrhythmia, have a leftwardly shifted and clockwise rotated heart, and have reduced heartbeat volume.  For the above mentioned conditions after surgery, both cosmetic and self-conscious symptoms are significantly improved. Therefore, correction of the deformity is well recognized and surgery is the best treatment method.  The surgical treatment of funnel chest has a history of more than 80 years and belongs to the exploratory stage. The general trend of the evolution and improvement of the funnel chest surgery is to reduce trauma, simplify the surgery, reduce recurrence, and develop a beautiful appearance.  At present, the most advanced “minimally invasive funnel chest orthopedic surgery (NUSS)” is a thoracoscopic sternal lift, which only requires a 0.5 cm incision on the lateral chest wall of the child to place the thoracoscope, and a 2-2.5 cm incision on both sides of the lateral wall to fix the plate behind the sternum, resulting in less trauma, less bleeding, and an operation time of 30-50 minutes. The operation takes only 30-50 minutes, with fast recovery, stable fixation of the plate, no incision in the anterior chest, and beautiful appearance. The best age for surgery is 4-10 years old.