The forward bulging of the sternum is called pectus excavatum and is a common thoracic deformity.
What are the causes of pectus excavatum?
The cause of pectus excavatum deformity is not yet clear. Most people believe that it is caused by overgrowth of the ribs and rib cartilage, and that the deformity of the sternum is secondary to the deformity of the ribs.
There are four main occurrences of corpus cavernosum.
1, the most common pectus excavatum occurs in adolescent children around the age of 11-14. This is a period of rapid growth and development, and parents may notice the child’s sternal protrusion deformity “overnight”, forming a peculiar chest.
The second common type of pectus excavatum is when the child is born or a short time after birth and parents notice the child’s sternal protrusion. When the child is 2-3 years old, the corpus cavernosum becomes more obvious.
3.Some children with anterior protrusion of the sternum secondary to heart surgery will develop a secondary peculoplasty.
4.There is also a case that the chicken chest is secondary to long-term bronchial asthma that has not been controlled, and in order to meet the breathing needs, the diaphragm movement is strengthened, pulling the Hao’s groove inward and gradually forming the chicken chest deformity.
What are the comorbidities of pectus excavatum?
Cockscomb chest often occurs alone. However, some of them are combined with other syndromes and become part of the syndrome, such as Turner syndrome, Noonan syndrome (NS), Marfan’s syndrome, Ehlers-Danlos syndrome (EDS). syndrome (EDS), Morquio syndrome, and so on.
About 1/4 of patients have a family member with pectus excavatum, indicating that pectus excavatum may be related to genetic factors.
How to classify chicken chest?
According to the different anatomical shapes and surgical treatment, there are 3 types of pectus excavatum.
1.Ship-shaped chest (keel chest);
2.Spherical pigeon breast (pouter pigeon breast);
3.Unilateral pigeon breast (lateral breast).
What is the epidemiology of chicken breast?
Sternal deformities (mainly including funnel chest and pigeon breast) are more common, with an incidence of about 1/400. of which, pigeon breast accounts for about 20%, and about 4/5 of the patients with pigeon breast are male patients.
What are the symptoms of corpus cavernosum?
The development of the heart and lungs is often normal in patients with corpus cavernosum, but their heart and lung function can be affected. In children with moderate or severe pectus excavatum, the efficiency of breathing is reduced due to the stiff forward projection of the chest wall. During strenuous exercise, the patient will use extra muscles to breathe, when breathing will be more strenuous than normal. In this way, the patient’s gas exchange and endurance will be affected. Children with pectus excavatum are often more prone to exertion than normal children of the same age. A common comorbidity of pectus excavatum is moderate asthma. Some children with pectus excavatum also have scoliosis, mitral valve prolapse, and connective tissue disease (including large vessel and heart valve malformations). Less commonly, patients have other connective tissue disorders, including arthritis, visual impairment, and low tissue repair function.
In addition to the damage to the patient’s physical health, pectus excavatum also produces significant damage to the patient’s mental and psychological health. Even a mild case of pectus excavatum can seriously affect a child’s self-image, reluctance to expose the breasts, low self-confidence, and even social impairment, especially in adolescents and adults.
What is the prognosis for pectus excavatum?
Pectus excavatum usually becomes more pronounced during adolescence and, in adulthood, becomes severe in patients with pectus excavatum. Negative effects secondary to pectus excavatum, such as scoliosis, cardiovascular and pulmonary conditions will become severe with age. Fitness exercise builds muscle, but will not significantly improve bony thoracic deformities such as corpus cavernosum and funnel chest. Of course, physical exercise is usually considered harmless.
Treatment of pectus excavatum
1.Orthopaedic brace
The treatment of choice for children, adolescents and young patients with pectus excavatum is non-surgical, i.e., the use of a tailor-made chest wall brace. The brace is effective in treating pectus excavatum by compressing the protruding area of the chest. Wearing the orthopedic brace for corpus cavernosum in strict accordance with the doctor’s instructions is the key to successful non-surgical treatment of corpus cavernosum. The principle of the brace is the same as the mechanism of orthodontics. The brace compresses the corpus cavernosum in both anterior and posterior directions. The design of the brace should be adjusted according to the severity of the child’s condition and whether the corpus cavernosum is symmetrical.
The main advantage of bracing is that it avoids the risks associated with surgery, such as bleeding, infection, trauma, and chest wall scarring. Regular follow-up while wearing the brace is an important guarantee of the desired result. As the child grows and the pectus excavatum improves, the brace will need to be adjusted accordingly if necessary.
If the developmental period is over, i.e. the child has reached adulthood, the sternum and rib cartilage are already set and the results of brace treatment are often not satisfactory at this time. Therefore, the treatment of brace must be before the child becomes an adult, and the younger the child is, the better the elasticity and plasticity of the thorax, the shorter the period of brace treatment (3-6 months), and the better the effect.
2.Surgical treatment
For patients with severe cases of pectus excavatum, surgical treatment may be necessary. The indications for surgery are adult patients or patients who have failed brace treatment.
The most common surgical procedures are the “Ravitch procedure” and the “anti-Nuss procedure”.
3. Other options
After puberty, some patients who do not want to undergo surgery can use exercises to make their chest muscles more developed to conceal the corpus cavernosum deformity.
Female patients can conceal mild to moderate corpus cavernosum deformity through breast augmentation.