Pediatric Pectus Excavatum
What is pectus excavatum?
Pectus excavatum (sometimes called cobbler's chest, sunken chest, or funnel chest) is the most common chest deformity, affecting between 1 in 300 and 1 in 500 adolescents. It is caused when several ribs and the sternum grow abnormally, which produces a caved-in or sunken appearance of the chest. Pectus excavatum is usually congenital (present at birth) and can get worse during the early teenage years, a time when bones grow rapidly.Because it affects the appearance of children, pectus excavatum can cause psychological and social problems. Moreover, it can hamper the ability of the heart and lungs to function normally, and can cause pain in the chest, back and elsewhere.
In moderate and severe cases, pectus excavatum may require surgery, which has proven very effective at correcting the condition and its psychological and physical effects. The most common types of operations are the Nuss procedure and the Ravitch technique. Children’s National’s team of experts in the Chest Wall Deformity Program can help families determine the best treatment option for their child.
Thoracoscopic Nuss procedure
The Nuss procedure is more popular because it requires much smaller incisions and is minimally invasive. Surgeons make two incisions on either side of the chest, through which they insert a curved steel bar under the sternum. The surgeons flip the bar so it pushes outward on the sternum. The bar usually stays in the body for about two years. When the bones have solidified into place, the bar is removed during a same-day operation.
Using the Ravitch technique, surgeons create an incision along the chest, through which they remove cartilage and detach the sternum. They then implant a small bar beneath the sternum to raise and hold it up in the desired position. The bar is left in position until the cartilage grows back, and can support the chest in a normal position. That usually takes about 1 to 2 years. The bar is then removed during a same-day operation.
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