Chest Wall Deformity

---

Pectus Excavatum, commonly known as funnel chest, is a condition where the central bone of the chest is sunken. The sunken appearance of the breastbone is commonly seen in young children and usually becomes more pronounced during adolescence when there is rapid growth.

In this condition, the cause of the unusual bone and cartilage growth is not unknown. In some cases there is no significant effect on heart or lung function., however, in others the impact can be more serious. Children and teenagers come to the attention of a paediatric surgeon due to concerns about the appearance of the chest wall.

The non-operartive intervention is the vacuum bell. It is a silicone suction device that is applied to he chest wall and worn for at least 2hrs daily for at least 2 years and in some cases the appearance of the chest wall may improve. It is probably best used in children around 10years of age when the skeleton is more pliable. This is ideal for patients who are too young for surgery or who do not want surgery but would like to try an intervention. The vacuum bell is effective in 40% of patients if worn correctly.

Pectus Excavatum can be surgically corrected using curved metal bars that are placed behind the breastbone to push it forward. The bars stay in place for approximately three years at which point they are removed. This operation is performed under general anaesthetic. Thoracoscopy and sternal elevation are always used when placing a bar to ensure it is performed as safely as possible. Cryonalgesia is used to freeze the nerves of the chest wall so that post-operative pain is well controlled. The nerves gradually recover and sensation returns around months post-oepratively.

The patient usually stays in hospital for 3-4 days. There are restrictions on the patient’s activities for the first 3  to 6 months after surgery.

Dr Carolyn Russell has extensive experience in chest wall surgery and regularly performs these operations at Sydney Children’s Hospital (SCH) in Randwick. Dr Russell established the Chest Clinic at SCH Randwick where patients are assessed and referred for photography, lung function tests, cardiopulmonary exercise tolerance testing or orthotists as needed. Patients can also see Dr Carolyn Russell regarding their chest wall concerns in her private rooms.

Pectus Carinatum, commonly known as pigeon chest, is a condition where the central bone of the chest protrudes. This appearance is most commonly noticed in later childhood and becomes more prominent during adolescence. Similar to pectus excavatum, the underlying cause of the abnormal growth of bone and cartilage is unknown.

The condition causes no impact on cardiac or respiratory function. Commonly, the child or parents have concerns about the appearance of the child’s chest and seek an opinion. These days, most patients with pectus carinatum are suitable for chest wall bracing and are referred to the SCH orthotist for fitting of a personalised brace. It is ideal to commence bracing for girls around 11-12 years of age and for boys around 13-14years of age.

The custom made brace needs to be worn for 22-23hrs per day for 3-6 months to achieve correction of their deformity. The brace is then worn overnight for the subsequent 3-6months. Some patients do not tolerate wearing the brace and may request surgical correction of their pectus carinatum.

Patients can see Dr Carolyn Russell regarding their chest wall concerns  at the Chest Clinic at Sydney Children's Hospital or in her private rooms.

Sometimes children develop complex chest wall deformities following surgery for correction of conditions they were born with, such as trachea-oesophageal atresia or a congenital diaphragmatic hernia. Soma babies are born with Poland's Sequence which variably involves anomalies of the chest wall, breast, nipple and upper limb -  these babies require assessment by a mulitdisciplinary team. In other circumstances, a chest wall deformity may develop following resection of a tumour. All of these conditions can be assessed and managed at the Chest Clinic at Sydney Children's Hospital in Randwick. Patients can also see Dr Carolyn Russell regarding their chest wall concerns in her private rooms.