Q: What kind of disease is pediatric funnel chest and chicken chest?
A: “Funnel chest” is a congenital thoracic deformity in which the lower part of the sternum is sunken inward and the adjacent rib cartilage is also sunken with it, forming a funnel-like appearance. In contrast, the lower part of the sternum protrudes outward.
Q: What is the cause of funnel chest?
A: There are three theories on the cause of funnel chest: one of them is that the sternum is pulled by the septum during growth and development, which gradually aggravates to form funnel chest. Another theory is that the overgrowth of the rib cage on both sides presses the sternum backward, causing the formation of a funnel chest. Nowadays, it is believed that funnel chest has some genetic factors.
Q: Are funnel chests and pectus excavatum caused by calcium deficiency?
A: Funnel chest is not caused by calcium deficiency.
Q: What are the risks and how does it affect life expectancy?
A: Since the changes in the ECG of patients with funnel chest are caused by the backward pressure of the sternum, medication and injections are ineffective and can only be solved by surgery. There is no theory that funnel chest has an effect on life expectancy, but because the sternum is pressing on the heart and lungs, it will affect the function of the heart and lungs in the long run to the point of causing other diseases, and will also affect the child’s school and social life to varying degrees. Chicken chest mainly affects the appearance and makes the patient’s psychosocial impact.
Q: What advanced methods of treatment are currently available?
A: We would like to introduce a minimally invasive surgery under thoracoscopic surveillance, which was first invented by an American doctor in 1998 and then quickly became popular worldwide. As shown in the picture, the highest point of the chest wall on both sides and the lowest point in the middle are marked, and the line formed by these three points is the path that the plate takes. As shown in the figure, different types of plates are selected according to the child’s age and the width of the thorax.
The curvature of the plate will also be adjusted to the shape of the child’s chest during the surgery. Then the thoracoscope is delivered to the chest cavity through a small incision, and the plate is safely and accurately delivered to the sternum under the surveillance of the thoracoscope and the sternum can be lifted. Based on this, we have invented the correction of the chicken chest, which is a simpler and safer method. First, we mark the highest point of the sternum and the corresponding intercostal intersection points in the mid-axillary line on both sides, and the line formed by these three points is also the path that the steel plate takes, then we make a 2-3 cm incision in the chest wall centered on the lateral marking points on both sides, free the upper and lower ribs in that area, and the rib bed is completely free. Different types of plates are selected according to the child’s age and the width of the thorax. During the surgery, the curvature of the plate is adjusted according to the shape of the child’s thorax.
The plate is then safely and accurately delivered through a small incision to the anterior marker point of the sternum and then penetrated to the opposite marker point, and the two ends are buried in the posterior rib bed of the rib to fix it, which allows the sternum to be compressed down and corrects the corpus cavernosum.
Q: What are the advantages of this surgery?
A: There are three obvious advantages of the new method compared with the traditional surgical method. 1. the wound is small and does not need to free the pectoralis major muscle, the sternum and ribs do not need to be cut off, so the recovery is very fast. 2. as you can see in the picture, this new method is very beautiful. 3. the operation time of the new method is short, generally in about 30-40 minutes can be finished, while the traditional method generally takes 3 hours or even longer. long time.
Q: What kind of discomfort will there be after the surgery?
A: The new method uses a steel plate to lift or lower the sternum, which needs to be pulled out after 2 years. In our experience, school-age children can ride their bikes to school 3-4 weeks after surgery.
Q: What preparations do I need to make before surgery?
A: The funnel chest surgery requires general anesthesia, so you need to do some routine tests such as CT 3D imaging of the thorax before surgery, and you should also know about the heart function. The more serious the impact of funnel chest on cardiopulmonary function, the more important it is to treat it as soon as possible.
Q: When is the best time to treat a funnel chest?
A: The funnel chest surgery itself is an elective surgery, the youngest patient is currently 3 years old and the oldest patient is 20 years old. Generally speaking, the best time for treatment is during the school age (6-7 years old). In the case of pectus excavatum, there is no age limit.
Q: My child is 5 years old and was found to have a funnel chest when he was 4 months old. He has been taking calcium supplements.
A: 5 years old should be a good age for treatment and minimally invasive surgery is recommended for immediate treatment. There is no need to take calcium supplements for a funnel chest.
Q: What is the difference between a funnel chest and a chicken chest?
A: Chicken chest is forward convex, while funnel chest is backward concave, the appearance is easy to distinguish.
Q: How long does the hospital stay take for minimally invasive treatment of funnel chest and pectus excavatum? Do you need blood transfusion?
A: Generally, the hospitalization time is about one week and you can be discharged. Blood transfusion is not necessary due to the minimal trauma.
Q: What do I need to pay attention to in caring for my child after surgery?
A: Within 3 months after surgery, you should follow the doctor’s instructions for regular review, and you should also send a few photos of your appearance regularly. For children with preoperative ECG and echocardiographic abnormalities, relevant examinations should be done after six months.
Q: When will the plate be removed?
The plates can be removed after 2-3 years when the patient’s deformity is corrected, and up to 5 years for some special (e.g., after asymmetric deformity correction, difficult cases requiring two plates for fixation) patients.
Q: Will the plates restrict the growth of the thorax as we get older?
No, the growth has been fully considered during surgery, and the plate fixation is slidable.