Pectus Carinatum: Severity, Impact, and Treatment Options - Pediatrics

Dr. Pei Rensheng reply Pediatrics

---

Hello: Pectus carinatum can be corrected with the use of braces and rehabilitation exercises under the guidance of a professional orthotist.

1.
What is a sternal developmental deformity? What are the causes?
Answer: A deformity of the anterior sternum that causes the chest wall to protrude forward is known as pectus carinatum.
This condition is quite common, but patients often feel embarrassed and may deliberately cover it up with clothing or avoid activities that expose their chest appearance.
A medical study published in 1990 indicated that pectus carinatum results from the disproportionate development of the sternum and the costal cartilages and ribs.
Clinically, although the shape of pectus carinatum may vary, the underlying causes are common and can be considered a syndrome.
Common factors involved in its pathogenesis include genetics, respiratory system disturbances such as bronchitis, asthma, pneumonia, sinusitis, or spinal developmental abnormalities like scoliosis and kyphosis, which can even affect the normal psychological development of adolescents.
2.
How is pectus carinatum corrected? Is it true that this skeletal condition cannot be corrected unless surgery is performed?
Answer: Twenty years ago, surgery was indeed the only treatment option.
Although bones and cartilage are rigid, they are living entities that can be reshaped with external forces as medical technology advances.
The younger the patient, the better the plasticity, and this plasticity can persist throughout life.
We apply orthopedic principles by using braces (orthotic devices) to exert external forces while also utilizing rehabilitation exercises to increase pressure within the thoracic cavity, aiming to reshape the sternum.
3.
What are the potential consequences if pectus carinatum is left untreated?
Answer: Most cases of pectus carinatum are idiopathic, meaning the cause is unknown.
Research indicates a strong genetic component.
Typically, it does not affect internal organs, but in severe cases, it can impact thoracic and cardiopulmonary development, lead to an unattractive appearance, and have long-term negative effects on the psychological development of adolescents.
4.
How are these sternal developmental abnormalities treated? How long is the treatment course?
Answer: Traditionally, from the 1950s to the 1970s, surgery was the standard method of correction.
It wasn't until 1979 that Dr.
Haje and his medical team in Brazil successfully used braces to improve symptoms of pectus carinatum.
In 1993, Mielke-Winter in the United States also successfully treated a teenage girl with pectus carinatum using plaster, braces, and corrective bands.
Today, with professionally customized pectus carinatum braces and appropriate physical therapy exercises, along with training guided by professionals, patients can achieve significant improvement within one to two years.
5.
Once symptoms of pectus carinatum improve, is there a possibility of recurrence?
Answer: This is a relatively long treatment course, potentially lasting one to two years or even longer.
The likelihood of recurrence depends on the patient's age, severity, flexibility, and compliance.
Generally, if a gradual weaning approach is taken under professional guidance, the chance of relapse after completely removing the pectus carinatum brace is low.
6.
At what age group is this treatment most suitable?
Answer: Childhood is the most suitable period, especially during adolescence when growth is rapid, leading to the best corrective outcomes.
Typically, a corrective brace can be worn for one to two years, but as children grow, they may need to transition to a second brace when the first becomes too small.
7.
Is this treatment applicable to adults?
Answer: Yes.
However, the patient's flexibility must first be assessed.
If flexibility is adequate, correction with a brace is feasible.
However, due to the varying daily lifestyles of adults, ensuring consistent brace wear and training is generally more challenging than for children.
Naturally, the younger the patient, the better the results.
8.
Are there any side effects or risks associated with this treatment?
Answer: Some patients may experience skin reactions, such as rashes.
However, wearing appropriate undergarments or applying topical ointments can help resolve these issues.
Additionally, excessive correction may occasionally occur, but if patients have regular follow-ups under professional supervision, the likelihood of this happening is low.
9.
Will wearing a pectus carinatum brace cause breathing difficulties? Can I remove it during physical activities?
Answer: A well-fitted brace should not affect breathing.
For certain contact sports or swimming, it is advisable to remove the brace.
The principle is that the shorter the duration of brace wear in daily life, the longer the overall treatment course will be.
Patients themselves must take responsibility for wearing the brace; our medical professionals can only provide guidance.
10.
Pectus carinatum patients should first seek evaluation at a thoracic surgery clinic before proceeding with correction.
Wishing you health and happiness.

Director of Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare, Pei Ren-Sheng.

---

Reply Date: 2016/07/07