What Is Funnel Chest and Pigeon Chest, and What Are Their Treatment Methods?

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Funnel Chest (Pectus Excavatum)

Funnel chest refers to a condition in which the sternum and ribs sink inward into the chest cavity. Although it may develop in both children and adults, it most commonly appears during early adolescence. Funnel chest, which generally has a hereditary tendency, is seen more frequently in males than in females.

What Are the Symptoms of Funnel Chest?

Because of the shape of the sternum, funnel chest can make it harder for the lungs and heart to function. Symptoms may appear both physically and psychologically.

Physical Symptoms

Difficulty breathing during exercise

Lower strength compared to peers

Fatigue

Chest pain

Irregular heartbeat

Psychological Symptoms

Feeling ashamed of the appearance of the chest

Decreased self-esteem

Depression

Individuals who have complaints of the above symptoms are advised to be examined by a Thoracic Surgery specialist.

How Is It Diagnosed?

A simple physical examination is sufficient to diagnose funnel chest. However, sometimes the deformity may not become apparent until early adolescence, or additional tests may be needed after the physical examination.

In such cases, X-rays are used to determine the severity of the condition and any possible additional disorders; computed tomography and magnetic resonance imaging are used to examine whether the chest presses on the heart and lungs; and echocardiography is used to evaluate heart function.

What Are the Treatment Methods for Funnel Chest?

Surgical Treatment

Surgical intervention aims to correct the chest deformity and improve the patient's heart and respiratory functions. The ideal age range for surgical correction of funnel chest is 7-14. Because the chest can more easily take its normal shape during the period of rapid growth, it is important to perform surgery before puberty.

Modified Ravitch Surgery

Modified Ravitch surgery is a traditional open surgical procedure that has been used for many years to treat funnel chest. In this method, a relatively long incision is made on the front of the chest wall, and the cartilaginous portions of the ribs that cause the chest to be pushed backward are removed. Thus, the sternum is pulled away from the heart and lungs toward the normal plane of the chest wall.

Nuss Surgery

Developed by American surgeon Dr. Donald Nuss, this technique is the most up-to-date treatment method used today. Nuss surgery is a closed procedure performed using minimally invasive methods.

The surgical process proceeds as follows:

If the patient smokes, they are asked to stop smoking at least two months before surgery.

General anesthesia is administered during surgery.

To correct the depression that has formed, a curved steel rod called a “bar,” specially prepared according to the patient's measurements, is used.

Two small incisions, each approximately two centimeters long, are made on both sides of the chest.

The prepared bar is inserted under the sternum through both openings, and with the help of special rotating instruments the curve of the bar is reversed, lifting the depression.

The placed bar is fixed by suturing it to the muscle tissue at the incision sites with non-absorbable sutures.

Depending on the patient's needs, 2 or, in rare cases, 3 bars may be used.

The surgery takes approximately 45-60 minutes

What Is the Recovery Process After Nuss Surgery?

After funnel chest surgery, patients are typically hospitalized for an average of 3-5 days, depending on their condition. Pain during the first 3 days is normal. However, this can be minimized with intravenous pain relief treatment. Patients discharged from the hospital are asked to rest at home for 2-3 weeks.

During the recovery period:

Sudden movements should be avoided so that the placed bar does not shift position.

During the first month, do not bend forward from the waist or twist sideways from the waist.

When getting out of bed or standing up, get assistance from someone and avoid putting weight on the chest.

During the first month, sleep on your back.

Light walks can be taken to regain strength.

Light sports activities can be started from the third month onward. Sports such as running, tennis and swimming are recommended to start after the sixth month.

When Are the Bars Removed?

This varies depending on the patient's age and the condition of the chest wall. Accordingly, the bars can be removed within 2-4 years. This procedure, which takes approximately 30 minutes, is performed under general anesthesia.

3D Anatomical Implant Technique

3D anatomical implant technology is a surgical method used to correct abnormalities of the chest wall with an implant specially designed according to the shape of the patient's chest (prepared based on 3D chest tomography coordinates). This implant is custom-designed to match the size and shape of the patient's chest. Therefore, using an implant designed specifically for each patient makes surgical intervention more accurate and effective.

Compared with traditional surgical interventions, this method is less invasive and carries less risk. In addition, the recovery process is shorter, allowing the patient to return to normal activities more quickly. 3D anatomical implant technology produces highly successful aesthetic results (80% of these operations are performed due to aesthetic concerns and poor appearance).

Treatment with a Vacuum Device

It is possible to correct chest deformity without surgery, especially in children. A special vacuum device is used for this.

The vacuum device, which is shaped like a rubber bell, operates by being connected to a pump. First, the device is placed on the front of the chest, then air is drawn out of the device with the help of the pump. This creates a suction or vacuum environment that pulls the chest and sternum forward.

When this device is used regularly over a long period, the deformity gradually corrects itself, and the chest wall and sternum begin to stay in the proper plane on their own.

How Often Should It Be Used?

For the vacuum device:

During the first few days, it is worn for approximately 30 minutes twice a day,

In the following 4-6 weeks, the duration of use is increased by 2 hours per day according to the doctor's advice,

In the early months, it is recommended that this duration be increased to 8-12 hours per day.

On the other hand, the vacuum device should be used for at least one year. The ideal duration of use is 18-24 months. During this period, determining and following the usage times in consultation with your doctor will increase the chances of success in treatment.

Pigeon Chest (Pectus Carinatum)

Pigeon chest refers to a condition in which the sternum and ribs protrude outward. It is the exact opposite of funnel chest. It occurs due to a disruption of the cartilage that connects the ribs to the sternum.

Pigeon chest, which is seen more often in males than in females, usually becomes noticeable after puberty and its severity increases with age. Although the exact cause of pigeon chest is not known, genetic predisposition is important.

What Are the Symptoms of Pigeon Chest?

Symptoms of pigeon chest may vary from person to person depending on the severity of the condition.

These include:

Difficulty breathing

Rapid heartbeat

Frequent respiratory tract infections

As with funnel chest, pigeon chest can be diagnosed by physical examination. In addition, X-rays taken from the front and sides, computed tomography and magnetic resonance imaging may be added to the diagnostic process.

During the diagnostic process, if an irregular heartbeat is detected in addition to pigeon chest, echocardiography may also be requested.

What Are the Treatment Methods for Pigeon Chest?

In the treatment of pigeon chest, two treatment approaches come to the forefront depending on the severity of the condition and the patient's situation.

For this procedure, an incision is made in the mid-chest area. Abnormal cartilage is removed, and the chest is pushed downward. In addition, where deemed necessary, a temporary metal bar is placed over the chest to hold the chest wall in the desired plane.

Since this is a painful procedure, the length of hospital stay after surgery varies depending on the patient's condition and pain control.

Abramson Surgery

Abramson surgery is a minimally invasive procedure performed through small incisions. It takes approximately 30-45 minutes and is performed under general anesthesia.

During surgery, as in Nuss surgery, small incisions are made on both sides of the chest. Through these incisions, a Lorenz bar, previously custom-prepared for the patient, is placed between the sternum and the muscle tissue and pressed downward. Surgery ends with the bar being fixed to the ribs on both sides of the chest wall.

After Surgery

Patients are generally asked to stay in the hospital for 4-5 days. During this time, the aim is to control pain.

Avoiding sudden movements is important.

Patients can return to routine life within 2-3 weeks; children can start school after two weeks.

In consultation with the doctor, only walking is permitted during the first month; swimming, running and tennis and similar sports may be permitted between 1 and 3 months; and other professional sports may be permitted after 6 months.

When Is the Lorenz Bar Removed?

The Lorenz bar placed by surgery is removed:

In patients under 18, after 2-3 years,

In patients over 18, after 3-4 years,

with a procedure lasting 30-45 minutes under general anesthesia.

Brace Treatment

The function of the brace used in the treatment of pigeon chest is similar to that of the plates used in dental treatment. The brace worn over the chest applies pressure to the ribs and sternum both from behind and from the front. Thus, over time, the chest bones return to their normal position.

It is recommended that the patient wear the brace 18-20 hours a day for 2 years. The brace can only be removed while showering or while doing sports or other activities.

To increase the success of treatment, it is important to pay attention to the duration of brace use and to follow the doctor's recommendations. According to research, with regular brace use over 2 years, it is possible to treat pigeon chest in 75-80% of cases.