Chest Wall Deformities
The chest wall is a cavity formed by the chest bone, called the sternum, in the front, our backbone at the back and ribs at front, back and sides. While our neck forms the dome of the cavity, diaphragm forms the border between the thoracic cavity and the abdominal cavity.
In children, the rib cage is relatively circular in size, but the growth of the cavity on anteroposterior plane lags behind its growth on the right-to-left plane. Therefore, the transverse diameter of our rib cage is much wider than the anteroposterior diameter.
The deformities of the rib cage, where vital organs, such as heart and lungs, and very important blood vessels, such as aorta, are located in, are broadly congenital in nature.
Moreover, the structure of the rib cage shows great variations based on age and personal characteristics.
Chest wall deformities do not cover a wide range of diseases; pectus excavatum and pectus carinatum account for most cases.
It is the most common type that accounts for up to 80% of all chest wall deformities.
In pectus excavatum, the deformity includes the collapse of the sternum (the breastbone).
Although genetic factors have been considered, a familial clinical picture is present only in half of patients with pectus excavatum.
Pectus excavatum is classified according to morphological features.
In pectus excavatum, severity of symptoms usually correlates with the extent the sternum is collapsed. No symptom is observed and the routine life is not influenced in most cases. If the breastbone is severely collapsing into the chest cavity, lungs are compressed and pulmonary functions can be compromised. Moreover, the heart is displaced to the left side of the body. The effect on the heart is most remarkably seen in the right heart, especially the right atrium.
If the effect on the heart and the pulmonary functions is negligible, pectus excavatum is just a cosmetic problem.
Surgery is the only treatment option as the problem is completely anatomic or physical. The principal underlying mechanism of pectus excavatum is the idiopathic overgrowth of the cartilaginous part of the breastbone.
There are two options in the surgical treatment of pectus excavatum; modified Ravitch (open surgery) and Nuss operation (closed or thoracoscopic). Both surgeries are common in correction of the sternal deformity and placement of metal rods or plates behind the bone to prevent the collapse.
Surgery is not considered or postponed until respiratory and cardiovascular symptoms of pectus excavatum decreases the quality of life.
Pectus carinatum is a protrusion deformity of the breastbone. Similar to pectus excavatum, it is classified according to morphological characteristics.
Asymptomatic pectus carinatum is principally a cosmetic problem, as the case for pectus excavatum. It accounts for 20% of all chest wall deformities. It is known that the condition is more frequent in men.
Although the exact cause is not known, it is more common in individuals with family members, who have similar conditions. The anticipated problem is the abnormal cartilaginous part of ribs. The condition is largely asymptomatic. Chest pain and exertional shortness of breath are reported for some patients. The major problem arises out of psychological and cosmetic complaints.
Poor quality of social life is the most common indication of surgery in pectus carinatum. The first method is Ravitch operation, while the other option is total subperiosteal resection of sternum.
Moreover, other chest wall deformities include Poland syndrome and sternal defects.