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Pectus Deformity Correction Program: A patient primer

The bones and cartilage of the chest — pectus in medical terminology — can be subject to deformity disorders.

What is pectus excavatum? 

Pectus excavatum is Latin for hollowed chest. It is a very common congenital deformity of the chest wall, where several ribs and the sternum grow abnormally. This commonly gives a caved-in or sunken appearance of the chest. It can either be present at birth or not develop until puberty.CausesThe disorder is assumed to be caused by overgrowth of the costal cartilage which connects the ribs to the sternum (center of the chest, or breastbone). As a child with the disorder grows through adolescence, the costal cartilage overgrowth restricts the expansion of the ribs and pushes the sternum inward. The disorder is estimated to occur in one of every 500 to 1000 children; it occurs in males three times as frequently as in females. Pectus excavatum can occur repeatedly in families, but most of the time it occurs randomly. At present, the cause is unknown.

What is pectus carinatum? 

Pectus carinatum is also a very common deformity of the chest wall, where the ribs and the sternum grow abnormally. This commonly gives a caved-out or pigeon chest appearance of the chest. It can either be present at birth or not develop until puberty. It is the opposite of pectus escavatum.CausesPectus carinatum is an overgrowth of cartilage causing the sternum to protrude forward. It occurs in 3 different ways. It is often evident in newborns as a rounded chest and as they reach 2 or 3 years old the sternum begins to grow outwardly. The most common occurrence for pectus carinatum seems to be in the 11-14 year old pubertal male undergoing a growth spurt. Some parents report that their child's pectus seemingly popped up 'overnight'. It may occur as a solitary congenital abnormality or in association with other genetic disorders or syndromes : Marfan syndrome, Ehlers Danlos Syndrome, Morquio syndrome, Noonan syndrome, Trisomy 18, Trisomy 21, homocystinuria, osteogenesis imperfecta, multiple lentigines syndrome, Sly syndrome and Scoliosis.

Treatment options 

Sunken chest is a deformity of the cartilage that connects the ribs to the breastbone. The deformed cartilage pulls the breastbone inward, giving the chest a caved in or sunken appearance. The condition occurs in about one in 800 children born in the United States each year and is three times more common among boys than girls.The surgeons at the Pediatric Heart Center have treated this condition using traditional cardiothoracic surgery and an investigational method that uses magnets to corrects chest deformity the way braces correct teeth. The surgical procedure options include the Ravitch procedure and the Nuss procedure. As of June 2015, cryoablation is offered in conjunction with the Nuss procedure for pain control. An additional benefit of this pain control method is that it has decreased the length of stay from 5-7 days to 2-3.

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