Pectus excavatum (sunken chest/funnel chest) often requires surgery. Our surgical treatments include the Nuss and Ravitch procedures at Children's Health℠.
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Refer a Patient with Pectus excavatum (sunken chest/funnel chest)
Pectus excavatum is believed to result from an abnormal growth of rib cartilage that causes the sternum (breastbone) to be pulled inward, resulting in a depression in the chest. For this reason, pectus excavatum is also known as sunken chest or funnel chest.
The condition occurs in at least 1 out of every 1,000 children and is more common in males.
Pectus excavatum can range from mild to severe, and your child may or may not have symptoms related to the heart or lungs.
Symptoms include:
Pectus excavatum often worsens with age and during growth spurts that occur in late childhood and adolescence. Some patients are very self-conscious because of the pectus excavatum deformity.
Correction of the deformity may play a significant role in improving the self-esteem and exercise intolerance of some patients.
To diagnose pectus excavatum, your child’s provider will do a detailed physical examination. After diagnosis, additional testing may be ordered to identify the extent of the chest wall deformity and any body system dysfunction, which may include the following tests:
The exact cause of pectus excavatum is unknown, but we do know it tends to occur in families, suggesting genetics may play a role. It may also be associated with Marfan syndrome, homocystinuria and Ehlers-Danlos syndrome.
Treatment is dependent on severity as well as symptoms and can range from simple observation to surgical repair.
This minimally invasive procedure usually requires a total of three small incisions located on your child’s chest. A curved metal bar shaped to your child’s chest is inserted under the ribs and is secured under the sternum to lift the chest. Multiple bars may be needed.
The bar is placed under direct observation using a small camera so the surgeon can safely pass the bar(s) behind the sternum. The bar is left in place for two to three years to allow the chest wall to remold. The bar is then removed during outpatient surgery.
This surgical procedure is for children and adolescents and is performed when bracing has not been successful or not possible due to the chest wall deformity. The procedure generally requires an incision across the chest.
The surgeon will remove the abnormal rib cartilage between the boney ribs and the breastbone which allow the breastbone to be pushed down and take its normal shape. An absorbable strut will be placed in your child's chest to keep the breastbone in place until the cartilage can regrow.
As with any operation, post-operative pain is a common concern. Our team has developed a protocol with the assistance of the pain team and anesthesiology to minimize the length of time requiring pain medication. Extensive education will be provided in the pre-operative visits by the clinical coordinator for the Pectus clinic.
During the procedure, the surgeon will use cryotherapy to provide pain relief in the areas of the chest wall affected by the surgeon. Most patients will require pain medication at time of discharge but are usually tapered off by the two-week post-operative evaluation.
The evidence does not support observation as a treatment strategy and while there are non-surgical options, the shape of the chest wall does not change without intervention.
Rare case reports are published that note uncompensated disability related to the pectus deformity in elderly patients. However, there is no data suggesting a shortened lifespan.
It can run in families, but may also occur without a family predisposition.
Absolutely. Working on posture, core strength and treatment for the chest wall deformity is critical to good outcomes. Physical medicine and rehabilitation is a valuable component of the center.