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Chest Wall Deformities

The pediatric surgery staff at Children's Hospital & Medical Center has specialized expertise and experience in treating pediatric chest wall deformities and treats a variety of these conditions with significant success.

Pediatric chest wall deformities include pectus excavatum, pectus carinatum, Poland's syndrome and Jeune's syndrome.  Although these are rare deformities, diagnosis and treatment of pectus excavatum is becoming increasingly more common. 

Pectus excavatum, the most common of these, is a depression of the anterior chest wall of variable severity that often grows worse during adolescence. This defect can run in families and is often not detected until late childhood. While clinical symptoms can be minimal, many children will complain of chest pain or fatigue. These defects can also make children self-conscious and limit their involvement in activities like swimming or other sports.

Patients with pectus excavatum may also have other associated health issues such as mitral valve prolapse, cardiac arrhythmias, scoliosis and Marfan's disease.  Repair of the pectus excavatum may improve your child's pulmonary function and may improve chest pain as well. After surgical repair, many children develop a better body image and become more involved in sports and social activities.

Pediatric surgeons Stephen Raynor, M.D., and Kenneth Azarow, M.D., have an extensive amount of experience repairing all chest wall deformities with highly successful outcomes.

How are chest wall deformities diagnosed?
Evaluation begins with a clinic appointment with one of our pediatric surgeons Stephen Raynor, M.D., or Kenneth Azarow, M.D. Further testing may include a CT scan of the chest, pulmonary function tests and a cardiac echocardiogram

If your child's condition is mild, close monitoring of your child may be recommended first to determine the best treatment option for you and your child. In some cases, physical therapy may be recommended to increase chest flexibility, improve posture and increase chest muscle mass. Severe cases that require surgery can be performed during summer or Christmas break to minimize time away from school.

How are chest wall deformities repaired?
The most common form of chest wall deformity, pectus excavatum, traditionally has been repaired with a large incision across the chest and removal of the cartilage from the involved ribs, also known as the Ravitch procedure. For the last 10 years, the Ravitch procedure has been largely replaced with a minimally invasive procedure called the Nuss procedure with excellent long-term results. 

The procedure involves making two incisions under the arm on either side of the chest to allow for insertion of a curved steel bar under the sternum. A separate, small incision is made to insert a small camera to provide direct visualization for the surgeon as the bar is passed under the sternum. The bar, which is individually curved for each patient, is used to push out the depression and is then attach to the ribs on either side. A small steel, grooved plate may be used at the end of the bar to help stabilize and attach the bar to the rib. The bar cannot be seen from the outside and is kept in place for two years. When it is time, the bar is removed as an outpatient procedure.

While most patients are candidates for the Nuss procedure, some still require and desire the Ravitch for more complex abnormalities.