- PECTUS EXCAVATUM
- PECTUS CARINATUM
- POLAROID SYNDROME
What is the cause of pectus excavatum?
The pectus excavatum or funnel chest is a developmental anomaly of sternum,costal cartilages and nearby ribs, the cause of which unknown. It may run in families and associated with anomalies like marfan,kyphosis,scoliosis and other connective tissue diseases. The deformity increases with aging.
It may be associated with symptoms like chest pain and breathlessness on exertion.
What is the outcome for a child with pectus excavatum?
Can have restrictive effects on lungs,constrict and impede heart function and can have psychological and emotional effects like negative body image,low self esteem and social awkwardness.
WHAT ARE THE INDICATIONS FOR SURGICAL TREATMENT ?
After the puberty if the defect is causing much physiological or psychological damage.
WHAT ARE THE TREATMENT OPTIONS FOR PECTUS EXCAVATUM ?
Open procedure(Ravitch procedure)
Minimally invasive procedure ( Nuss procedure)
WHAT IS RAVITCH PROCEDURE ?
This is an open technique where a horizontal incision is made , the deformed cartilages are excised leaving the perichondrium. Sometimes, a sternal osteotomy is made to bring the sternum more anteriorly
WHAT IS NUSS PROCEDURE ?
Nuss Procedure Bar Placement
Nuss Procedure Bar Flipped
Nuss procedure involve lifting the depressed sternum by introducing a metal bar called, Nuss bar as depicted above.
What is needed preoperatively?
Pectus severity index should be measured by a CT scan. If the index is above 3.2 only, surgery is justified by the insurance providers.
A cardiac and respiratory evaluation is mandatory before planning operation.
What is the cause of pectus carinatum?
The causes of pectus carinatum is not known. It stops post-puberty.
HOW IS CARINATUM TREATED ?
Bracing from young age prevent the progress of carinatum.
When is surgical treatment considered for pectus carinatum?
Surgery is usually not indicated in pectum carinatum unless bracing fails or the sternum or ribs are too rigid for remoulding.
If surgery is needed, a Ravitch procedure is used. In this ,a horizontal incision is made, the protruding cartilages are excised leaving perichondrium and the sternum is repositioned.