The funnel-shaped deformation of the chest (the ICD assigns it the code Q67.6) is a hollow chest, which is a congenital developmental anomaly in which the sternum is retracted along with the anterior ribs. The etiology of this deviation has not yet been fully established, but to date it is assumed that hereditary factors still play the leading role. The main cause is connective tissue dysplasia, and in addition, cartilage in the chest area.
What is the danger?
This pathology can be even more aggravated as the child grows up, often becoming the cause of changes in posture, as well as heart and lung diseases. The diagnosis of this deviation is made on the basis of examination, thoracometry, as well as based on the results of radiography and other studies. Therapeutic treatment methods, unfortunately, are ineffective. Against the background of the progression of pathology and malfunctioning of the chest organs, doctors prescribe an operation. We will talk more about funnel chest deformity, its causes, symptoms and treatment below.
Description of the disease
The funnel-shaped chest, as already noted, is a congenital pathology that is associated with the retraction of the anterior thoracic regions. This deviation is considered the most common among all cases of congenital malformations of the chest. According to various sources, doctors observe such a deformation in 2.3% of the inhabitants of our country. This disease, due to its tendency to progress in a number of situations, is a serious danger to the general health of patients.
Causes of pathology
The etiology of the funnel chest deformity, unfortunately, is not yet fully understood. In this regard, at present, experts are considering about thirty hypotheses of the formation of a funnel-shaped breast. True, it has been statistically established that hereditary factors have the leading value in the development of this pathology. This theory is confirmed by the presence in sick relatives with absolutely identical congenital malformations. In addition, in patients suffering from a funnel-shaped chest, more often than in other people, additional developmental abnormalities are revealed.
Dysplasia
The main reason for the presented deformation is cartilage, and in addition, connective tissue dysplasia, which occurs due to some enzymatic disorders. The inferiority of the tissue can occur not only before the birth of the child, but also in the process of its further growing up. With age, chest depression can often progress, resulting in a curvature of the spine along with a decrease in the volume of the chest cavity, displacement of the heart, and impaired function of all organs in the area. Histological examination of cartilage, which was taken from patients of different ages, confirms the aggravation of changes. For example, as the cartilage grows, it can loosen more and more, an excess amount of intercellular substance appears in it and numerous cavities and foci of asbestos degeneration form.
Pathology classification
Currently, experts describe about forty syndromes, which are accompanied by the formation of a funnel chest deformity. But the absence of one pathogenetic theory of the development of the disease, with which everyone would agree, makes it difficult to create a single classification. The most successful option that most modern doctors use today is the Kondrashin classification. So, according to her, this pathology is classified as follows:
- According to the appearance of the deformity, the disease can be asymmetric or symmetrical.
- In the form of deformity, the disease is flat-edged and ordinary.
- By the type of deformation of the sternum, the pathology can be typical, saddle-shaped or helical.
- According to the degree of deformation, the first, second, and also the third degree of funnel-shaped deformation of the chest are distinguished.
- By stage, this disease is compensated, subcompensated or decompensated.
- In combination with other congenital anomalies, this disease can be uncombined and combined.
Gizycka Method
To determine the degree of development of such a form of the chest in Russian traumatology and orthopedics, the Gizycka method is used. As part of its application, the smallest and greatest distance, which is located between the front surface of the spine and sternum, is measured on the lateral radiograph. Next, the smallest distance is divided by the largest, and thus the resulting strain factor is obtained. The indicator "0.7" and more speaks of the first degree, "0.5" - of the second, and even less indicates the third.
Symptomatology
Manifestations with this form of the chest directly depend on the age of the patients. In infants, a slight impression of the sternum is observed. In addition, paradoxical breathing is also present, with this symptom, the ribs with the sternum sink at the time of inspiration. Among younger patients, sternal pressure is more pronounced, and a transverse groove can be found directly under the edges of the costal arches. Preschoolers diagnosed with a “funnel-shaped breast” are more likely to have colds than other peers.
Poor posture in schoolchildren
In addition, students with this diagnosis show a violation of posture. The process of curving the ribs and sternum becomes fixed. The chest in this case looks flattened, the shoulders are down, the edges of the costal arches are raised, and the stomach is protruded forward. Symptoms of paradoxical breathing as they grow older can gradually disappear. Thoracic kyphosis is observed, which often occurs in combination with scoliosis.
Other signs
Also, with funnel chest deformity in children, increased fatigue can be noted along with sweating, irritability, decreased appetite, pallor of the skin and weight loss in comparison with the age norm. Such children can endure physical activity extremely poorly. In addition, they reveal certain violations in the work of the heart and lungs. They are characterized by frequent bronchitis with pneumonia, and some patients may complain of pain in the area of the heart.
Deformity Diagnosis
Examination of patients with such a deviation as a funnel-shaped chest implies an accurate diagnosis along with an assessment of the general condition of the patient. In the framework of the diagnosis, the severity of disorders on the part of the heart and lungs plays an equally important role. As a rule, the diagnosis does not cause any difficulties at the stage of the first examination. To assess the degree of deformation, thoracometry and various indices are used, which are determined taking into account the volume of the depression in the sternum along with the elasticity of the cell, its width and some other indicators. In order to clarify the information of thoracometry, chest radiography is performed in two projections and computed tomography of organs in this cavity is performed.
Respiratory system tests
Among other things, a patient with congenital funnel chest deformity is referred to a pulmonologist and cardiologist, prescribing a number of different studies of the respiratory system. Spirometry confirms a decrease in lung capacity. An electrocardiogram reveals a displacement of the axis of the heart. As part of echocardiography, mitral valve prolapse is often detected. In addition, tachycardia with increased venous pressure and other disorders are often observed in patients with such deformity. As practice shows, with age, the pathological manifestation becomes more clear and pronounced.
Pathology treatment
Therapy of the funnel-shaped breast can be carried out by traumatologists, orthopedists and thoracic surgeons. Conservative treatment for this disease is ineffective. An indication for surgical intervention is increasing disorders of the circulatory and respiratory organs. In addition, sometimes surgical intervention is performed to eliminate a cosmetic defect. Exercise therapy is very effective for funnel chest deformities.
Early surgery
Operations are recommended to be carried out mainly at an early age, six years is considered the optimal period for this. Such an approach makes it possible to provide conditions for healthy chest formation, preventing the development of secondary spinal deformity along with the appearance of any functional disorders. In addition, children are much easier to tolerate surgery, since their chest is more elastic, and therefore the correction is not so traumatic.
Currently, doctors use about fifty surgical interventions in the treatment of funnel chest deformities. All methods are divided into two categories: palliative and radical. The goal of the radical technique is to enlarge the chest. This technique involves dissecting the sternum and cartilage of the ribs. During this operation, part of the bone is removed, and the front sections of the cell are fixed using special sutures and all kinds of fixatives, for example, knitting needles or plates and so on. Palliative intervention involves masking the defect without adjusting the volume of the chest area. In this case, silicone prostheses are sewn into the defective space.
Third degree
An indisputable indication for radical surgical intervention is the presence of a funnel-shaped chest deformity of the third degree. Before surgery, patients are required to undergo a comprehensive examination and treat various chronic infectious diseases, such as, for example, bronchitis, sinusitis, chronic pneumonia and the like.
An indication for the palliative intervention technique is the first and second degree of deformation. Palliative surgery is performed only for adults, since during the development of the child’s body, the silicone prosthesis is able to visually exfoliate and the cosmetic effect of the operation will be lost. Patients over the age of thirteen with the presence of slight deformation can perform correction of the position of costal arches. As part of this operation, the arcs are cut off and fixed crosswise on the surface of the sternum in front.
In order to create the most comfortable conditions in the postoperative time, the patient goes to the intensive care unit, in which he is in a state of drug sleep. Against this background, they carefully monitor the organs of the chest cavity, and in addition, the functions of the respiratory system. To prevent hypoxia, oxygen is inhaled using a nasal catheter. From the second day they begin breathing exercises, and a week later - physiotherapy exercises with massage.
What is the effectiveness of surgery for funnel chest deformity?
Surgical Results
Assess the results of the operation will be possible only after six months. At the same time, the cosmetic effect is evaluated along with the degree of restoration of the functional activity of the chest organs. As part of this, a complete elimination of the funnel-shaped chest along with the absence of paradoxical breathing and the correspondence of the anthropometric indicator to standard numbers for a specific age is considered a good result. In addition, there should be no disturbance on the part of the heart, and in addition, normal indicators of acid and salt metabolism should be recorded.
Conclusion
Doctors consider the result to be satisfactory, in which a slight deformation remains along with modest functional disorders, but as such there are no complaints. An unsatisfactory result will be a relapse of the deformity with the persistence of complaints that the functional indicators have not improved in any way. As a rule, a good result is achieved in 50% of patients, satisfactory in 25%, and unsatisfactory in 10%. According to research, the best results are observed against the background of sternum plastic without the use of fixatives. But it is important to note that at the moment there is no single universal technique that could equally well suit absolutely all patients.
Are they taking the army with a funnel chest deformity? It depends on the type and severity of the pathology. If, as a result, respiratory failure of at least the second degree has appeared, then conscription to military service is excluded.