chest wall malformations center
The pediatric surgery team at Dayton Children’s has the experience and skill to treat patients with chest wall disorders, like pectus excavatum and pectus carinatum. With the establishment of the chest wall malformations center, we now have the ability to offer our chest wall patients the latest equipment, technology and pain management to treat their disorder.
What is pectus carinatum?
A genetic disorder of the chest wall that makes the chest jut out. This happens because of an unusual growth of rib and breastbone (sternum) cartilage. The bulging gives the chest a birdlike appearance. The condition is sometimes called pigeon breast or pigeon chest.
How is pectus carinatum diagnosed?
Health care providers diagnose pectus carinatum based on an exam and a child's medical history. If needed, they might also order tests such as:
- Chest X-ray to check the severity of the condition
- Imaging scans like computed tomography (CT) or magnetic resonance imaging (MRI)
- Electrocardiogram to see how the heart is working
- Pulmonary function tests to check the lungs
- Genetic testing to look for related syndromes
How is pectus carinatum treated?
Kids and teens with mild pectus carinatum might not have breathing problems or worry about their appearance. If so, they don't need treatment.
Kids whose bones are still growing can wear a chest brace. Much like how braces realign teeth, a chest brace will push the breastbone back to a normal position. They can remove it for sports, showering, and other activities, but typically need to wear it for at least 23 hours a day at first and then a minimum of 8 hours a day once the initial phase has concluded.
What type of bracing does Dayton Children's use to treat pectus carinatum patients?
The new bracing technology utilized by the Dayton Children’s surgery team is custom made for each patient and adjusted using a pressure monitor. Previously, any adjustments had to be made manually by tightening the brace itself. Now, adjustments are made with the help of a pressure measuring device that measures compression of the chest in pounds per square inch (PSI).
The new brace provided to Dayton Children’s patients is also easier to wear, less bulky and has to be worn for only half the time than the bracing traditionally used to treat pectus carinatum.
What is pectus excavatum?
A deformity of the chest wall that causes several ribs and the breastbone (sternum) to grow abnormally, giving the chest a concave, or caved-in, appearance.
How is pectus excavatum diagnosed?
Pectus excavatum is a genetic disorder. Although kids are born with it, it may not be apparent for the first few years or sometimes even until the teenage years. Mild cases might be barely noticeable.
Severe cases can cause a deep hollow in the chest and could affect the heart and lungs. The visual appearance of pectus excavatum might cause self-esteem issues for some kids.
Healthcare providers diagnose pectus excavatum based on a physical exam and a child's medical history. If needed, they might also order tests such as:
- Computed tomography (CT) scan and/or a chest MRI to see the severity and degree of compression on the heart and lungs
- Echocardiogram to test heart function
- Pulmonary function tests to check lung volume
- Exercise stress testing to measure exercise tolerance
How is pectus excavatum treated?
Pectus excavatum can cause limitations to exercise and other physical activities or be completely harmless if it's not affecting how the lungs or heart work. Surgery often can correct the condition and treat any heart or lung issues. Physical therapy and exercises to strengthen muscles are also helpful.
What is Dayton Children’s approach to treat pectus excavatum?
The surgery team at Dayton Children’s has the experience, skill and modern equipment to treat patients with pectus excavatum. And now, they have they latest pain management techniques to assist with recovery.
To repair pectus excavatum, appropriate patients may undergo a surgery that involves the Nuss procedure. The Nuss procedure involves placing a steel bar under the sternum to exert pressure to correct the chest deformity. The procedure itself is minimally invasive and requires two small incisions. The bar is removed two or three years later, once the deformity has corrected itself and becomes permanent. Ideally, this surgery is performed on patients ages 12-14. Any younger and the procedure would have to be repeated, and much older, the bones have hardened, making correction more difficult.
Dayton Children’s now offers pectus excavatum patients a new approach to manage pain using cryoablation, a process that uses extreme cold to freeze nerves and prevent pain. Using this approach, patients will be virtually pain-free following surgery without the use of opioids or other traditional pain medications and decreases their inpatient stay at the hospital.
What is the outlook for a patient with pectus excavatum?
The Nuss procedure can improve the way the chest looks and help a child's self-esteem. Although the recovery time can be difficult, most kids are happy with the results.
questions or concerns?
If you have additional questions, we're here for you. To contact the pediatric surgery clinic, please call 937-641-5020.
For follow up appointments, second opinions or to reschedule please click the button below to request an appointment with our pediatric surgery team. If your child is an existing patient, you can also log in to MyKidsChart to schedule directly with your provider for follow up care.