Spring 2013 - Children & Chest Wall Deformities
Many people have never heard of a chest wall deformity, and even fewer have heard about the corrective surgeries. "That's because they are not that common, but we evaluate children with chest wall deformities here almost daily," says J. David Hoover, MD, pediatric surgeon at WakeMed Children's.
Chest wall deformities are developmental anomalies that occur in childhood during growth and development. They are not usually present at birth. "It does run in families, but there isn't anything you can do to prevent it," said Dr. Hoover.
J. DAVID HOOVER, MD, FACS AND J. DUNCAN PHILLIPS, MD, FACS, FAAP, OF WAKEMED SPECIALTY PHYSICIANS – PEDIATRIC SURGERY, HAVE THE LARGEST CHEST WALL DEFORMITY PRACTICE IN THE STATE AND SEE PATIENTS FROM ACROSS NORTH CAROLINA. THEY FOCUS ON MINIMALLY INVASIVE APPROACHES AND PROVIDE A NUMBER OF SURGICAL OPTIONS TO MEET THE INDIVIDUAL NEEDS OF PEDIATRIC PATIENTS.
Get Checked Early
Parents may notice their child has a caved-in or protruding bird-like chest, but young kids usually aren’t bothered by it. “Older children and teens may notice a change, but some won’t say anything,” said Dr. Hoover. Parents may notice they are shying away from social settings such as pools or shared dressing areas.
“It is best to see children as early as possible,” said Dr. Hoover. He has seen patients as young as 6 years old. Early cases of some chest wall deformities (specifically those described as ‘bird chest’) can be treated with a brace to eliminate the need for surgery. A common misconception is that children will grow out of the defect. “In fact, most do not,” said Dr. Hoover. “They may not get worse, but we usually see the defect getting more pronounced in older, untreated children.” As the chest wall stiffens, corrective options are reduced.
Surgery is typically done during the mid-teen years, but earlier interventions are recommended at times for younger children who are very symptomatic. Once corrected, recurrence is not very common.
Some children do not have any noticeable symptoms. However, some may develop pain, trouble breathing or exercise intolerance. It may be caught during an athletic physical or by a pulmonologist examining a child with symptoms similar to asthma. Symptoms may be due to compression of the heart and/or lungs.
If a child needs surgery, a bar will likely be used to correct the sternum. Many children report relief following surgery. “One young patient could not run down the office hallway before surgery,” said Dr. Hoover. “In our follow-up appointment, he could push me down the hall.”
Pectus excavatum is an abnormal configuration of the chest, where the sternum (breast bone) pushes into the heart and lungs. This gives the chest a caved-in or sunken appearance.
Pectus carinatum is a forward protrusion of the sternum (breast bone) and/or ribs. This is described by some as a bird-like chest appearance.