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Chest wall deformities
1Division of Pediatric Surgery, University of Michigan, Ann Arbor 48109-0245, USA.
Insights
Pediatric chest wall deformities require accurate categorization and timely surgical intervention for optimal outcomes. Early correction is crucial for conditions like Pectus carinatum, Poland syndrome, Jeune syndrome, and sternal fusion defects to address physical, psychological, and cardiopulmonary concerns.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Children present with chest wall deformities due to physiological and psychological reasons.
- A 22-year experience in operative management of over 300 pediatric cases is detailed.
- Accurate categorization and timely referral are essential for effective management.
Purpose of the Study:
- To review the operative management of pediatric chest wall deformities.
- To categorize common chest wall deformities and their management strategies.
- To emphasize the importance of early intervention for specific conditions.
Main Methods:
- Review of a 22-year surgical experience with over 300 pediatric patients.
- Classification of chest wall deformities including Pectus carinatum, Poland syndrome, Jeune syndrome, and failure of sternal fusion.
- Assessment of deformity severity, associated problems, and timing of surgical referral.
Main Results:
- Pectus carinatum is common, causing physical pain and psychological distress.
- Poland syndrome management involves early hand correction and later chest wall correction if needed.
- Jeune syndrome and failure of sternal fusion require early infancy correction due to severe cardiopulmonary compromise.
Conclusions:
- Optimal management of pediatric chest wall deformities necessitates accurate diagnosis and appropriate timing of surgical intervention.
- Early surgical correction in infancy yields the best results for severe conditions like Jeune syndrome and sternal fusion defects.
- A multidisciplinary approach is vital for addressing the physical, psychological, and functional aspects of these deformities.
Abstract:
Children present with chest wall deformities to their pediatrician because of physiologic and psychologic causes. We have a 22-year experience in the operative management of more than 300 of these children. Initial evaluation should accurately categorize the deformity, determine the severity, assess for associated problems and refer the child at an appropriate time for further management. Pectus carinatum is the most common deformity that can cause physical pain from an intercostal neuropathy and psychologic pain from the unsightly protuberance. Poland syndrome is managed by early correction of the hand deformity and later correction of the chest wall deformity if necessary for psychologic or functional reasons. Jeune syndrome and failure of sternal fusion may have severe associated cardiopulmonary compromise. Each should be corrected in infancy for the best results.