Chest Deformity - 5 Modern Methods Of Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Chest deformity

Chest deformities are curvatures of the sternum and ribs, which can vary in severity.

Congenital deformity of the sternum is not common and is diagnosed in no more than 2% of people worldwide. Most often, people have acquired deformities that develop in childhood and adolescence.

Congenital deformities are caused by genetic abnormalities. The acquired curvatures of the thoracic region develop against the background of various diseases.

With deformation of the chest, bones and muscles suffer, which protect the internal organs from external damage. Treatment of such a pathology should be started as early as possible. If there is no therapy, the likelihood of severe complications increases. They relate to the work of the cardiovascular system, respiratory system and digestion.

Content:

• Causes of breast deformity
• Symptoms
• Classification and types
• Congenital deformities
• Keel chest deformity (chicken breast)
• Acquired deformities
• Diagnostics
• Treatment of deformity changes in the chest
• Complications
• Prevention

Causes of breast deformity

Congenital deformities of the chest can occur under the influence of the following factors:

• Genetic predisposition.
• Turner syndrome, Down syndrome, Marfan syndrome.
• Disorders due to the formation of the skeleton: ribs, spine, chest.

The acquired deformity of the chest can be caused by the following factors:

• Bone tuberculosis.
• Scoliosis and kyphosis.
• Injuries and burns of the chest.
• Rickets.
• Lung diseases.

Symptoms

The main symptoms of chest deformity are:

• Changes in the structure of the spine. Moreover, not only the thoracic, but also the cervical and lumbar regions will suffer.
• Curvature of the pelvic bones, different leg lengths. These symptoms are more typical for scoliosis.
• Increased muscle tone on one side of the body, formation of a muscle cushion.
• Expansion of the intercostal spaces. In appearance, this area will resemble a hump, but it is located in front.
• Disturbances in the work of the respiratory system and heart.
• Torsion - displacement and twisting of the vertebrae.
• Curvature of the neck, irregular shape of the skull, asymmetry of the face.
• Chest and back pain. It occurs due to infringement of nerve fibers.

Classification and types

Chest deformities are divided into congenital and acquired. They, in turn, also have certain subspecies. There is a classification of deformities depending on the place of their localization and on the severity of the disorder.

So, 2 large groups of chest deformities:

• Congenital deformities.
• Acquired deformities.

Congenital deformities are divided into the following subspecies:

• Funnel-shaped deformation. At the same time, the human chest is sunken, looks depressed inward. Experts call such a violation a shoemaker's breast.
• Keel-like deformation. The patient's chest is pushed forward and resembles a boat keel. The people call this violation "chicken breast".
• Flat. Both the chest and ribs are flattened towards the anteroposterior axis.

Children who have a funnel-type sternum are more likely to get sick. Every fifth child develops a lateral curvature of the spine, which causes the development of scoliosis.

There are congenital deformities that are rarely diagnosed.

These include:

• Sternoskisis or congenital cleft sternum. With this violation, the sternum can be partially or completely split.
• Musculoskeletal defect. With this violation, not only the chest is affected, but also the spinal column, as well as muscles and internal organs (Poland's syndrome).
• A curved chest or Currarino-Silverman syndrome. This deviation is not common.

Acquired deformities are classified as follows:

• Emphysematous deformity, which develops against the background of pulmonary emphysema. The human chest begins to resemble a barrel in appearance.
• Paralytic deformity, accompanied by an expansion of the space between the ribs. At the same time, the side of the chest becomes smaller in size, and the clavicle and shoulder blades begin to bulge. This type of disorder leads to diseases of the lungs and pleura.
• Scaphoid deformity. The patient develops a rather long depression, which resembles a boat in shape. This violation is a consequence of syringomyelia.
• Kyphoscoliotic deformity develops with curvature of the spine, or after suffering from tuberculosis.

In terms of shape, deformations can be of the following types:

• Symmetrical.
• Asymmetrical.
• Rear.
• Front.
• Side.

The severity of the deformity is determined by the depth of displacement of the chest and the degree of pressure on the heart.

In this regard, there are:

• Compensated deformity (first degree) with an impression of no more than 2 cm. With such a deformation, the heart does not suffer.
• Subcompensated deformity (second degree). The pressure is 2-4 cm. In this case, the heart can be displaced by 3 cm.
• Decompensated deformity (third degree). The depression exceeds 4 cm, the heart is displaced and reduced in size. This pathology is a health hazard.

In childhood, decompensated deformity is rarely diagnosed. The earlier corrective treatment is started, the better the results will be. Therapy should be carried out until there are no complications from the heart and lungs.

Congenital deformities

With deformities of the congenital type, the shape of the chest will be distorted in a person. This is due to the underdevelopment of the ribs and muscle frame. Sometimes the ribs in the baby are completely absent.

Funnel chest deformity

The funnel-shaped type of deformity of the sternum occurs more often than others. This disorder is diagnosed in 90% of all cases of dysplastic curvatures. Girls are affected less often than boys. The "shoemaker's chest" appears with a pronounced depression in the center and lower part of the chest. This is due to the underdevelopment of the cartilage of the ribs.

Factors such as:

• Incorrect growth of cartilage and bones.
• Congenital defects of the diaphragm, which are accompanied by its shortening.
• Incorrect placement of the fetus in the uterus.

If the deformity is severe, the child will suffer from surges in blood pressure, from curvature of the spine. There are violations in the work of internal organs. The heart and lungs are the first to suffer.

Keel chest deformity (chicken breast)

In a patient with a chicken breast, the ribs and sternum protrude forward. Often this pathology is diagnosed in preschool children. This violation does not affect health and is only a defect in appearance. To date, doctors do not know for certain the reasons for such a violation, but there is an assumption that it may be associated with an abnormality of the genetic plan.

Over time, this deformation will progress. However, it will not be able to inflict serious harm to internal organs. However, with such a violation, the heart can change shape and will resemble a drop. The person will start to get tired faster, he may experience shortness of breath and tachycardia.

Flat chest

In a person with this disorder, the front and back of the sternum is smaller than in other people. A flat chest cannot be called a disease. Deformation refers to the developmental features of a particular organism. It does not affect the work of internal organs, therefore, corrective measures are not shown to such patients.

A person with a flat chest has the following physique features:

• High growth.
• Shoulders too narrow.
• Long limbs.
• Inconsistency of height and body weight.

Children with a flat chest are more likely to get colds, sometimes developmental delay is observed.

Musculoskeletal defect (Poland syndrome)

Poland's syndrome is a severe pathology of the development of the costo-muscular apparatus. The patient has a deformed chest and spine, which leads to changes in the internal organs. Bony structures are often displaced.

People with Poland syndrome have several disorders at once:

• The pectoralis major and minor muscles are absent.
• Toes are spliced or too short.
• The ribs are either missing or severely deformed.

In half of the people with this defect, deformities are caused by genetic abnormalities.

With severe deformity, the patient has impaired respiratory function. It is the lungs that suffer from Poland's syndrome in the first place.

Convoluted sternum (upper keel, Currarino-Silverman syndrome)

A curved sternum is not often diagnosed. This violation is manifested by a protruding groove, which is located in the upper chest. The costal cartilage will be overgrown. The part of the chest that is located on the opposite side will have a normal appearance. Such deformation does not affect human health, but spoils his appearance. To get rid of it, you need the help of a plastic surgeon.

Congenital cleft sternum (Sternoskisis)

With this violation, the sternum will be partially or completely split. This anomaly is considered rare, although it is diagnosed in about 2% of the total population of the Earth.

The cleavage can be H-shaped, upper or lower. This pathology is considered dangerous, as it progresses all the time. A sick person's heart will not be covered with ribs, it is located directly under the skin. If you look at the chest, you can see the beating of the organ. All people with sternoskisis need surgery.

Acquired deformities

There are a wide variety of deformities that develop in a person over the course of life. They are caused by various diseases and in themselves worsen the patient's health.

• Emphysematous chest. This pathology is caused by emphysema of the lungs. The human chest takes the shape of a barrel. The patient suffers from breathing problems, and then abnormalities in the work of the heart join.
• Paralytic chest. This deformity develops due to pulmonary pathologies. The lateral parts of the sternum and its anteroposterior regions decrease, and the intercostal spaces become wider. The sinking is different on both sides, so the shoulder blades move asynchronously during breathing.
• Scaphoid chest. There is a depression in the center of the sternum. The scaphoid chest develops in pathologies of the central nervous system, when cavities are formed in the spinal cord and in the medulla oblongata. This disorder is called syringomyelia.
• Kyphoscoliotic chest. The kyphoscoliotic chest is a consequence of bone tuberculosis. Sometimes the deformity develops against the background of other pathologies of the chest organs. By itself, this curvature negatively affects the work of the heart and lungs. The violation is incurable.

Diagnostics

Without fail, the patient is prescribed a chest x-ray, which is performed in two projections with the calculation of the Gizycka index. This study allows you to determine the severity of the curvature, to detect if there is a displacement of the heart, as well as disturbances in the work of the lungs. Scoliosis is diagnosed with X-ray.

Additional survey methods include:

• Computed tomography. It is prescribed to patients with severe deformity, the study is carried out in order to clarify whether the patient needs the help of a surgeon. CT provides information about the compression of the heart, the degree of its displacement, the state of the lungs.
• Magnetic resonance imaging. It is carried out with significant deformations and its asymmetric varieties of 3 or 4 degrees.

In order to assess the work of the heart and blood vessels, the patient undergoes spirography, ECG and ECHOKG.

It is not uncommon for infants to have no deformity. However, the curvature manifests itself at an older age, when the child begins periods of active growth (age 5-8 years or 11-15 years).

Treatment of deformity changes in the chest

The features of therapy depend on the type of deformity. Also, the doctor takes into account at what stage of development she is. Treatment is started as soon as possible for patients whose heart and lung function is impaired due to deformation.

The main tasks that need to be achieved by treatment measures:

• Get rid of deformation.
• Eliminate pressure on internal organs and bring their performance back to normal.
• Eliminate a defect in appearance, improve the quality of human life.

Conservative treatment

It will not be possible to cope with the deformation with conservative methods. They are only practiced to stop the progression of the disease.

Methods of exposure to the human body can be as follows:

• Massage. Point techniques are used, only a doctor can implement them.
• Physiotherapy.
• Wearing a corset.
• Swimming.
• Breathing exercises.

To cope with an already existing deformity, the help of a surgeon is required.

Vacuum bell

If the deformation has just begun to form, then a method called a vacuum bell is used. It allows you to cope with the violation, provided that the person's chest is pliable. A vacuum is created in it, which corrects the existing distortions. The maximum effect of the procedure can be achieved at the age of 6-7 years. If the therapy does not work, then an operation is required.

Ferré dynamic compression system

This system is designed to correct the existing asymmetry in the chest area. Each specific device is developed for a person on an individual basis.

It consists of several components:

• Aluminum alloy plate. It is adjusted to fit the part of the chest that protrudes forward.
• The mechanism responsible for supporting the torso. It is located on the back side.
• A device for measuring the pressure exerted by the structure on the human body.

This system is used to correct deformity in childhood, as well as as part of a comprehensive treatment regimen.

If the patient's age is over 20 years old, then a significant result will not be achieved. Such treatment is well tolerated by all patients, since it does not impair their quality of life and does not cause discomfort.

As defects are corrected, the structure is transformed by adjusting the applied pressure. Treatment times vary widely and depend on the specific clinical case. If the design was used in the early stages of curvature formation, then it becomes possible to avoid the operation.

Orthoses

Orthoses are medical devices that are actively used to correct chest deformities. When a patient is diagnosed with keeled curvature, a corset is prescribed to give the upper body the correct position.

The area of the chest that protrudes forward will be compressed by the corset. Its regular use allows you to eliminate the existing deformation, as well as correct a defect in appearance. During treatment, the doctor must correct the pressure exerted by the orthosis.

Significant results can be achieved only when treatment was started at an early age. Adolescent deformities lend themselves to correction, since in this period the bone tissue is quite flexible and responds to external influences. In severe deformities, it will not be possible to achieve a result only with the help of orthoses.

It will take a long time to wear corrective devices. The minimum usage time is 12 hours a day. You need to tune in to long-term treatment. With this approach, after 1-1.5 years, the chest will acquire an anatomically correct position.

Surgical correction

It is possible to cope with the deformation of the chest with the help of surgical intervention, but it is important to choose the technique that suits a particular patient. There are many corrective operations, but most of them boil down to an osteotomy. During the procedure, the doctor makes a bone incision, after which he implements the necessary manipulations.

• Sterno-chondroplasty. Mark Ravich's method. An incision is made on the anterior chest wall that crosses across the chest. The surgeon then separates the muscles and resects the costal cartilage and sternum (sternotomy). The next step is the placement of the correction plate. After that, the fabrics are sewn together. Such an intervention is very effective, but at the same time traumatic for the patient. Many people refuse surgery because the incision is made on the front of the chest. The postoperative sutures look not very aesthetically pleasing.
• Abramson's method. This method of treatment is not as traumatic as the intervention described above. Therefore, this type of operation is chosen by a greater number of patients with deformity. The plates are sewn to the ribs during this process. When the desired effect is achieved, these plates are removed.
• Kondrashin's method. The incision is made in the anterior sternum. They make it not horizontal, but vertical. The deformed cartilage is then excised using a wedge-shaped method. Similarly, deformed bones are excised, the xiphoid process is crossed. The operation ends with suturing the dissected tissue and suturing the chest.
• Timoshchenko's method. If the operation is performed on a boy, then one incision is made under the pectoral muscles. When a girl needs correction, two incisions are made. In the area of deformation, the skin is peeled off, the muscles are separated from the ribs and the ribs themselves are removed while preserving the perichondrium. The rib is shortened by a few centimeters. In the upper part of the deformation, a metal plate is attached, which is fixed on the ribs. It follows the anatomically correct shape of the chest. After a few months, this plate is removed.
• The Nass method. This operation is indicated for funnel chest deformity. It is characterized by low trauma. During the procedure, two incisions are made on the sides of the chest. Metal plates are inserted into them, which give the sternum the correct shape. A few years later, these structures are removed. The procedure is performed under general anesthesia. The patient must remain in the hospital for 7 days. Then for about 30 days he will need to limit physical activity, only walking is allowed. Sports are excluded for the next 3 months. In six months, the person will be able to return to a full life, since the rehabilitation will be completed. He ceases to feel the plates inside the chest, the pain goes away.

Video: Health "Shoemaker's Chest" - Chest Deformation:

Complications

If therapy is not started on time, then the risks of developing severe health consequences increase. Especially in this regard, funnel-shaped curvature is dangerous, since a person's lungs are squeezed, and the heart shifts from its normal place.

The most significant risks include:

• Malfunctions of the heart and blood vessels, deterioration of lung function. The ribs begin to sink in and put pressure on the internal organs. This leads to their displacement, which negatively affects health. If left untreated, the patient may experience blood pumping. This condition threatens to stop the heart muscle.
• Decreased lung volume. The pressure of the ribs on the organs leads to their compression. They pump less oxygen, which affects the body as a whole.

Prevention

Somehow it will not be possible to prevent the development of congenital deformity. Prevention can be implemented only to prevent acquired curvature.

Specialists give all patients a single recommendation - to start treatment on time. It is important that children play sports, which will create a strong muscle frame around the spinal column.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.