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Funnel chest (pectus excavatum)
Is funnel chest common?
Is pectus excavatum common? In fact, pectus excavatum is a very common type of chest deformity, accounting for over 90% of all anterior chest wall deformities. Additionally, the incidence rate of pectus excavatum is quite high; some statistics indicate a rate of one in four hundred people, while others say it's one in a thousand. This means that at least one in a thousand people has pectus excavatum, or even one in four hundred. The reason we might think that the incidence of pectus excavatum is not very high is because those affected typically do not voluntarily lift their shirts to show their condition to friends. However, if they go to the hospital wanting to address their condition, they will reveal their pectus excavatum to the doctor. Moreover, if not corrected, pectus excavatum tends to become more noticeable with age, particularly during the growth spurts of adolescence. Thus, pectus excavatum is actually a very common condition.
How long will the pectus excavatum steel bar be removed?
In correcting pectus excavatum deformity, a steel plate is used either behind or in front of the sternum to lift the indented sternum by nailing it up or suspending it with steel wires. Theoretically, the longer the steel plate is left in place, the more stable the correction of the deformation. However, if the steel plate is left in place for too long, since it is under stress, it may produce more scar adhesions with the indented sternum and surrounding chest wall muscles, and even form calcified bone scabs. Removing it at this point can cause more damage to the patient’s chest, arms, or sternum. Therefore, theoretically, it is best to remove the steel plate for pectus excavatum after two to three years. For children under ten, it is recommended to remove it after two years; for older children or adults, it is recommended to remove it after three years.
Can funnel chest heal itself?
Most parents and doctors hope that funnel chest can heal on its own, but the truth is that most cases of funnel chest cannot heal spontaneously. Imagine if it's a small sapling that has grown crooked from a young age, already deformed, with the sternum indenting inward and backward. As the chest continues to grow, especially during puberty, the funnel chest will become more and more pronounced. Just like a crooked sapling, if it is not corrected, as it grows, the indentation and deformity will become more prominent. Of course, there is an exception. Some children are found to have funnel chest within the first year after birth, which may be due to the pressure on the sternum from the arms and legs during pregnancy while in the mother's womb. We know that children are curled up in the womb, and this positioning of the arms and legs in front of the chest can also cause compression of the chest cavity, leading to an inward deformity of the sternum. However, after birth, as the arms and legs stretch out and the pressure causing the indentation on the chest is relieved, the deformity of the indented sternum may gradually improve. However, most cases occur before the age of one, and the likelihood of this happening decreases significantly after one year of age.
Pectus excavatum is seen in what lesions?
Pectus excavatum can be divided into two categories: The first type is simple pectus excavatum, and the second type is pectus excavatum combined with other diseases. Simple pectus excavatum is a condition in itself and can exist independently, meaning that children with pectus excavatum may not have other pre-existing diseases. Of course, there is also pectus excavatum combined with other diseases, the most common of which are connective tissue disorders, where the incidence of pectus excavatum is significantly higher among patients. This suggests that pectus excavatum may be closely related to the genes that promote or inhibit cartilage development. Additionally, pectus excavatum may also be related to diseases in patients with congenital diaphragmatic hernia. Some cases of congenital Marfan syndrome may also be related, as well as some children who might have airway stenosis or congenital diseases of the lungs and bronchi. These types of congenital diseases may also be accompanied by pectus excavatum. In summary, whether it is simple pectus excavatum or that combined with other diseases, it can itself form a pathological condition and may also be accompanied by other congenital diseases, leading to secondary pathological changes.
Does pectus excavatum affect enlistment?
Regarding the current conscription system, a mild case of pectus excavatum does not affect enlistment. However, it is known that the sternum is positioned directly in front of the heart and lungs in a normal individual. In children or patients with pectus excavatum, the inward and backward indentation of the sternum can directly compress the heart or lungs. In severe cases, this compression can prevent the heart from expanding effectively and fully, severely compressing and deforming the heart, and even affecting the opening and closing of the valves within the heart, leading to incomplete valve closure. As a result, the cardiac and pulmonary functions of such patients can be impacted to a certain extent, especially in those with moderate or severe pectus excavatum. Without timely correction, this condition can impair the patient's ability to perform physical activities, particularly strenuous labor or training exercises in the military, impacting both heart and lung functions. In addition to the physical aspects, there is also a social impact within the military. Due to the deformity of the chest cavity, patients might face misunderstanding or discrimination from others in their unit, which can damage their self-confidence and even lead to feelings of inferiority.
Can funnel chest recover by supplementing with calcium?
There was a time when many parents consulted about calcium supplementation for pectus excavatum, not only many parents but also many doctors in primary hospitals thought that pectus excavatum was caused by a lack of calcium. However, it was found that many children with pectus excavatum are actually very tall and slender. So, can these tall children also be lacking calcium? In fact, calcium deficiency leads to rickets, where beading deformities form between the hard bones and cartilage of the ribs, appearing on both sides. This beading deformation and the inward, backward indentation of the sternum seen in pectus excavatum are completely different conditions. Pectus excavatum is mostly caused by congenital genetic factors, while calcium deficiency or supplementation relates to an acquired condition. Thus, these congenital and acquired diseases are unrelated, meaning that calcium supplementation has no restorative effect on pectus excavatum.
Pectus excavatum should go to which department?
Regarding the registration of patients or children with pectus excavatum, if it is for children and the consultation is only about the hereditary aspect of pectus excavatum or its etiology, consider registering at the pediatrics or child health department. It is also feasible to consult the genetics department. If the consultation is about treatment options for pectus excavatum, including methods of treatment, consider registering at the thoracic surgery department. Thoracic surgery can provide advice and methods for the treatment of pectus excavatum, including both surgical and non-surgical options. Of course, not all hospitals have a thoracic surgery department; generally, municipal third-level, first-class hospitals are equipped with thoracic surgery departments. If there is no thoracic surgery available, consider registering under the general surgery department.
Is pectus excavatum hereditary?
In current medical technology, although no genes exclusively associated with pectus excavatum have been identified, there is evidence suggesting genetic predisposition when pectus excavatum coincides with other conditions. For instance, the incidence of pectus excavatum is significantly higher in patients with congenital connective tissue disorders, such as Marfan Syndrome, and is linked to certain genes within this syndrome. Additionally, patients with congenital diaphragmatic hernia also show an increased incidence of pectus excavatum. Moreover, the condition is more prevalent in patients, or children, who have subglottic airway stenosis or congenital bronchopulmonary dysplasia. Thus, these evidences confirm that pectus excavatum, as a disease in itself, is directly or indirectly related to congenital genetic factors, indicating a certain hereditary nature.
Why can't people with funnel chest gain weight?
In clinical observations, we have found that children with pectus excavatum generally do not have as good nutrition as normal children, and are not as plump. This may be related to the deformity of the chest indentation. We know that the normal cross-section of the thorax on a CT scan is oval-shaped, with the heart and lungs located behind the sternum. In children with pectus excavatum, the sternum is compressed backward toward the spine, which deforms and even pushes the heart completely to one side. This compression of the heart limits the blood's ability to fully return to the heart, and may even prevent the valves from closing completely, leading to valve insufficiency. As a result, both cardiac and pulmonary functions are somewhat impaired. Therefore, 80% of children with pectus excavatum experience exercise intolerance, meaning they cannot run as well as normal children, which also indicates poorer physical fitness and, comparatively, a lesser appetite. Recent studies have found that children with pectus excavatum also have slightly weaker immune functions, and their digestive and absorption capabilities are not as good as those of typical children. Poor exercise capacity and digestive function ultimately lead to poorer nutrition in children with pectus excavatum, making them less plump than normal children.
Can funnel chest heal itself?
Actually, a portion of children with pectus excavatum can heal on their own, especially those who are newly born and discovered to have pectus excavatum. This is because children are curled up while in the mother's womb. In some cases, their hands and feet might be placed in front of the sternum, pressing it backward and inward, causing a deformity. However, once the mother gives birth and the child's limbs unfold, the pressure on the sternum is relieved. As the chest grows, it gradually returns to its normal shape, and these children with pectus excavatum can be cured. On the other hand, another group of patients do not have pectus excavatum at birth, but develop a noticeable chest indentation as they grow older. These patients, when they are young, can also be treated with conservative methods, such as using a vacuum bell for pectus excavatum to gradually draw the indentation outward. With its stabilizing effect, as the child grows, the deformity can be slowly corrected. Of course, there are also children who might have a more rapid skeletal development, and essentially become "set" in their ways. At this stage, they may require surgical intervention to treat the condition. In summary, a portion of pectus excavatum patients can be healed, while another portion requires active intervention and treatment.