Thoracic concavity is an abnormal development of the rib cage in which the sternum grows inward, creating a gap in the chest wall. Learn about the rib cage concavity process in Turkey.
What is concavity of the rib cage?
Thoracic concavity is an abnormal development of the rib cage in which the sternum (breastbone) grows inward, resulting in a noticeable and sometimes severe indentation in the chest wall.
Also known as "sunken chest" or "funnel chest".
Thoracic concavity occurs in both children and adults, but is most commonly seen in the early teenage years.
Adults often have been aware of their breasts for many years before seeking treatment.
Symptoms and causes of pectus excavatum
What are the symptoms of concavity of the rib cage?
Patients may have less space in the chest, which may limit heart and lung function.
Symptoms can be both physical and psychological.
Physical symptoms can include:
- Shortness of breath when exercising
- Low stamina compared to peers
- pain in chest
Psychological symptoms may include:
- Big embarrassment from the appearance of the chest
- Self-esteem issues
- clinical depression
Reasons for an uneven rib cage
An uneven rib cage can cause problems with your breathing, posture, and possibly confidence in your body.
Some causes of an uneven rib cage include:
accident or trauma
If you have had trauma or trauma to your ribs such as a fracture or a sprain, you may have an uneven rib cage.
If it's been a long time since the accident, your ribs may require surgery to restore symmetry.
If it occurs only a short time later, you can talk to a thoracic surgeon to evaluate your injury and help you recover smoothly.
If you've had an uneven rib cage since birth, it may be due to a birth defect.
You may have a missing rib or your rib cage may be dilated in nature.
If your rib cage is causing you tightness or pain, you should talk to your doctor.
rib cartilage deformities
Deformities such as pectus excavatum and pectus excavatum affect approximately 1 in 1,500 children.
These deformities cause the chest to curve outward or inward.
Many cases of rib deformity are corrected with a brace, but some may require surgery.
If the rib cage is uneven or slightly protruding, it may be due to weak muscles.
The abdominal muscles play a large role in holding the rib cage in place.
If your muscles on one side of your body are weaker than the other, this may cause one side of your rib cage to protrude or cause you to sit unevenly.
If you have scoliosis, you may also have uneven ribs.
Because of the abnormal curvature of your spine, other parts of your body may adjust to accommodate the curvature.
Diagnostics and tests
How is pectus excavatum diagnosed?
Concavity of the rib cage is diagnosed through a simple physical examination.
Often, the defect doesn't become noticeable until the early teen years.
More detailed examinations - including chest MRI or CT scans and heart-lung performance testing - give us accurate measurements of how dangerous the position of the chest is and its effect on heart and lung function.
An echocardiogram and pulmonary function test (PFT) may also be done to evaluate concavity of the chest.
Management and treatment of pectus excavatum in Turkey
How is the treatment of concavity of the rib cage?
Thoracic concavity can be treated surgically.
The primary goal of thoracic pectus excavatum surgery is to correct the chest deformity to improve the patient's respiratory and cardiac function.
Repositioning the sternum outward reduces pressure on the heart and lungs, allowing them to function normally.
The appearance of the chest is also greatly improved, treating any psychological symptoms that may be present as well.
Thoracic concavity can be corrected using a minimally invasive surgical technique called the Noss procedure or the traditional surgery known as the Ravic procedure. Your surgeon will discuss the most appropriate procedure for your situation based on several variables.
Action Nos Nuss Procedure
After inserting a camera small chest to guide the operation, Two small incisions are made on both sides of the chest, each about 4 cm long, then a curved steel rod (designed to be suitable for each individual case) is inserted under the sternum to correct the depression and is fixed to the chest wall with a special stabilizer on both sides.
Then the doctor closes the wound with absorbable sutures.
The process generally takes between one and two hours, depending on each case.
The penis is left in place for 3 years and is subsequently removed on an outpatient basis.
ravic procedure Ravitch Procedure:
Also known as "conventional" or "open" surgical repair of pectus excavatum, Ravic's procedure involves an incision in the front of the chest while removing the enlarged cartilage portion of the ribs that has caused the sternum to be pushed back.
This procedure allows the sternum to be pulled forward, away from the heart and lungs and to the normal level of the chest wall.
Often a small plate with screws is used to hold the shear in its new position.
Alternatively, a small metal rod can be placed behind the sternum to hold it in place for 6 to 12 months.
The penis is later removed with a simple outpatient procedure.
This rod is smaller than the metal rod used for the Nos procedure.
Recovery after surgery and cryoablation
- A new way to reduce severe pain after a NOS procedure significantly shortens the hospital stay and reduces the need for opioid analgesics.
- The new technique - cryoablation - is used to "freeze" the intercostal nerves that provide sensation to pain in the chest wall.
In parallel with injecting local anesthesia (anesthetic medication) into these nerves, in addition to oral pain relievers given before and after surgery, cryoablation led to a decrease in pain in chest patients.
- Traditionally, patients undergoing the Nos procedure require a one-week postoperative hospital stay with epidural anesthesia, followed by several weeks of opioid medication after hospital discharge.
This latter measure is a concern, considering that opioid therapy may increase the risk of addiction.
- With cryoablation, most patients can now go home the day after surgery.
Some patients do not need any intravenous or oral opioids in the hospital.
Those who need oral opioids usually stop using them within one to two days.
Prior to Cryoablation-assisted Noss, a required recovery period of a month or more meant that school-age patients had to undergo surgery during the summer to avoid class absences.
Now, shorter hospital stays and shorter recovery time give patients more flexibility in scheduling their surgery, which can often be done during their winter or spring breaks.
What are the benefits of surgical repair of pectus excavatum?
The goal of pectus excavatum repair is to relieve pressure on the heart and lungs that may impair their function.
This usually leads to better breathing, increased exercise tolerance, and relief of chest pain.
It is normal for patients with pectus excavatum to think as if their breathing and stamina were normal before surgery and then realize that they are significantly better after.
In patients whose main problem lies in the abnormal appearance of the chest, there were drastic positive changes in their self-esteem and self-confidence.
Complete recovery was observed in patients with clinical depression, including the possibility of discontinuing the antidepressant medication they were taking.
Both the Nuss procedure and the Ravic procedure give excellent results, and patients are always satisfied with the way they feel and look after recovery.
The return rate of the problem for both procedures is less than 1%.
What are the risks of surgical repair of pectus excavatum?
Surgical repair of pectus excavatum, like other major surgeries, carries risks. While both the Nuss procedure and the modified Ravich technique are safe and effective procedures, complications, although rare, can occur.
Possible complications of surgical repair of pectus excavatum include:
- Pneumothorax (air around the lung).
- Pleural effusion (fluid around the lung).
- Displacement of the steel bar.
- Return of thoracic concavity after penis removal.
- damage to surrounding structures.
Outlook / Prognosis of the disease
If I don't have surgery, will pectus excavatum harm my heart and lungs or reduce my life expectancy?
There is no evidence that pectus excavatum reduces life expectancy or causes increased damage to the heart and lungs over time.
However, it is common for people to develop more symptoms over time. This is likely due to advanced age and increasing difficulties in compensating for functional impairments associated with pectus excavatum.
This, however, does not mean that damage will occur.
If I have pectus excavatum and need heart surgery, can both surgeries be done at the same time?
Yes. Doctors have performed combined cases of cardiac surgery with pectus excavatum repair with excellent results. This requires a coordinating approach between the surgeons who perform both procedures.