Pectus Deformities

Abstract

Chest wall deformities are sometimes noted in newborns or infants, or alternatively they might become apparent during childhood or adolescence. Chest wall malformations are presumed to be the result of rib cartilage overgrowth, which leads to either sternal depression (pectus excavatum) or protrusion (pectus carinatum). In the Northern Hemisphere, pectus excavatum deformities comprise almost 90 % of these anomalies with pectus carinatum comprising about 5 %. Early reports of surgical repair of pectus deformities involved radical cartilage resection techniques and sternal osteotomy to either elevate or depress the sternal plate. The most common technique as applied by Ravitch led to higher recurrence rates of pectus excavatum or pectus carinatum when performed in young patients who had not yet attained skeletal maturity. The most severe problem related to the radical cartilaginous resection methods was the development of acquired asphyxiating thoracic chondrodystrophy. Since the introduction of Nuss procedure in 1998, a new methodology for repairing pectus excavatum without rib resection has become increasingly adopted. Later, noninvasive compression techniques for pectus carinatum deformities were introduced which significantly reduced the need for operative repair of this particular chest wall deformity.