1.What is funnel chest?
Pediatric funnel chest is the most common congenital chest wall deformity (90%), with a male to female ratio of 4:1.
Pediatric funnel chest is a funnel-like chest wall deformity formed by the lower sternum and rib cartilage sinking toward the midline. Most commonly, the third rib cartilage to the seventh rib cartilage is sunken deeper into the midline, and the ribs and rib cartilage in this part are bent medially or laterally toward the spine to form the two sides of the wall, although the tip of the saber is upward, the whole saber is downward, forming the lowest point of the funnel. The upper and lower part of the thorax becomes longer, and the distance between front and back is shortened. In severe cases, the deepest depression at the lower end of the sternum can be in contact with the spine, or even reach the side of the spine.
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 cause of this disease is still not completely clear. In recent years, it has been found that funnel chest is related to diaphragmatic insufficiency, and some scholars found that children with congenital diaphragmatic hernia are prone to complication of funnel chest; some scholars also found that the content of zinc in rib cartilage of children with funnel chest is reduced, while the content of calcium and magnesium is increased; the resistance to tension, stress and bending of rib cartilage of children with funnel chest is reduced; and the morphology of type II collagen is disordered.
4.Is funnel chest hereditary?
There is a certain tendency of heredity, according to the research, 37% of the children have genetic tendency.
5.Can funnel chest heal by itself?
Individual children can heal on their own.
6.Does the disease worsen progressively?
Most of the children have typical manifestations at birth, and 90% of them can be diagnosed within one year of age. The disease is mostly stable at the beginning, but in early adolescence, when the bones are developing rapidly, the disease will rapidly worsen progressively, the depression deepens, and the sternum rotates, 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. The lung volume of most children with funnel chest is slightly lower than that of normal children, but still within the normal range; however, the pumping function of the heart decreases during strenuous activities and returns to normal after surgery.
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 the compression of heart and lungs, such as shortness of breath and palpitations after activity.
(3) chest wall deformity.
(4) Psychological disorders, mental abnormalities.
9.Funnel chest needs to be differentiated from those diseases
Funnel chest needs to be distinguished from Marfan syndrome, rickets and scoliosis.
10.What is the best age for surgery of funnel chest?
The best age for surgery is from 3 to 12 years old, and most of the surgeries after 12 years old require the placement of two Pectus bars (commonly known as NUSS in China).
Most of the surgeries after 12 years of age require the placement of two Pectus bars (commonly called NUSS orthopedic plates in China), and the placement time should be 2-5 years.
11.What are the indications for surgery of funnel chest?
(1) Moderate or severe funnel chest deformity with depression depth > 2cm or hydrolysis volume > 20ml or funnel index (F2 I) > 0.1; Haller index > 3.25 on CT.
(2) Pulmonary function suggests restrictive or obstructive airway pathology, susceptibility to upper respiratory tract infection, reduced tolerance for strenuous activity, and shortness of breath when running or climbing stairs.
(3) The heart is displaced by pressure, and the 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 brace can reduce the symptoms and delay the development of the disease.
13.What are the surgical methods?
In 1980, Dr. Donald Nuss of Children’s Hospital of King’s Daughter in Virginia, U.S.A. developed the minimally invasive surgery (Chinese people used to call it – Nuss Minimally Invasive Surgery for Funnel Chest), which has replaced the traditional surgery.
14.What is Nuss Minimally Invasive Surgery for Leaky Gut Chest?
Nuss minimally invasive surgery is to make a small incision of about 2 CM on each side of the thoracic wall, and under the guidance of thoracoscope, a tailor-made metal plate (NUSS orthopedic plate) is implanted, which convexes the sternal depression outward, and all the deformed rib cartilage which was concave before the surgery is also pushed outward by the NUSS orthopedic plate at the same time. The NUSS orthopedic plate should be left in the body for at least 2 to 3 years and then removed after the thorax has grown and developed normally. The surgery can be done safely under non-thoracoscopic guidance by experienced people, and we now complete the surgery without thoracoscopy to reduce postoperative thoracic complications.
15.What are the advantages of Nuss minimally invasive surgery?
Nuss minimally invasive surgery has the following advantages: small wound, less bleeding, short operation time, only about 1 hour for skilled people; because the muscle and cartilage are preserved intact, the chest becomes full and beautiful immediately after the operation; the operation corrects the chest wall deformity and improves the heart and lung function; because the incision is hidden on both sides of the chest wall, the aesthetic appearance can be taken into account, which is especially important in girls.
16.Is the incision and post-operative scars of Nuss surgery big?
No! Traditional surgical methods such as sternal reversal and sternal supination require a large incision of 15-20cm in the middle of the anterior chest wall, leaving a large scar in front of the child’s chest after surgery: Nuss surgery only makes a small incision of about 2cm on both sides of the chest wall, taking into account the aesthetic appearance of the chest wall, which is especially important in girls.
17.How to recover after surgery and what are the precautions?
(1) Instruct the child to eat a diet high in protein, calories and vitamins, such as meat, eggs, milk, fresh fruits and vegetables.
(2) If necessary, give intravenous fluids to replenish energy and vitamins, and apply antibiotics and hemostatic drugs.
(3) Supplement the diet with foods high in calcium, such as shrimp, kelp, sesame seed paste, etc., and pay attention to appropriate amount of exercise and vitamin D supplementation while supplementing calcium.
(4) Children should be fasted from food and water on the day after surgery, and those without abdominal distension, nausea and vomiting can eat on the second day after surgery, and generally eat liquid or semi-liquid diet first, and gradually transition to normal diet.
(5) The patient can move to the ground properly about 3 days after surgery.
(6) Avoid strenuous sports for one year after surgery.
15.How many days after surgery can I be discharged from the hospital?
4-5 days
16.Is there any recurrence after Nuss surgery?
The recurrence rate is 1-2%.
17.What is the experience of pediatric surgery Nuss in Mianzhi City Hospital?
We are one of the early units (2003) to carry out Nuss surgery in China, and have completed more than 100 cases of surgery for children aged 3-15 years old so far, so we have rich experience.
18.How much does Nuss surgery cost?
The cost of Nuss surgery is much lower than in the past, about 30,000.
19.Are there any complications of Nuss surgery?
Complications of Nuss surgery include pneumothorax, bleeding, infection, Pectus bar displacement, pleural effusion, funnel chest recurrence, heart injury, etc. However, the incidence of these complications is very low, and most of them occurred in the early stage of Nuss operation, and with the accumulation of surgical experience, these complications have become very rare.
20.Is the experience of Nuss surgery important?
The operation of Nuss surgery is relatively simple, but the experience of the surgery is very important. The postoperative result, especially the shape of the thorax, is very different between a less experienced surgeon and a more experienced surgeon, and there is a certain risk of Nuss surgery.
23.Do I need to make an appointment in advance for hospitalization in your hospital?
It is better to make an appointment in advance.
24.Do I need to have a review after Nuss surgery?
Once every 2-3 weeks after surgery, and then once every 3-6 months
25.Is it possible to review online
Yes