Keel-shaped chest deformity: causes, treatment, surgery
Keel strain - anomalous development of the chest. It is characterized by curvature of the chest: the front comes out forward, takes the shape of the keel of the boat. In the people such deformation received the name "chicken breast".
Reference. According to ICD-10, pathology belongs to the group Q67.7 “Kilevoid breast”, which contains only one subgroup - congenital chicken breast.
The main causes of the violation are the genetic factor and heredity. They are associated with a failure of the growth rate of the rib cartilage and connective tissue pathologies.
The following diseases can provoke the development and progression of curvature:
- injuries of the chest and spine,
- ankylosing spondylitis,
- heart disease with myocardial distension,
In rare cases, the violation occurs as a result of a broken arm or body of the sternum.
Symptoms of strain and how dangerous it is
The main symptom of pathology is the swelling of the sternum, ribs and costal cartilage forward (see photo).
Other characteristic symptoms that make up the complete clinical picture of pathology include:
- retraction of ribs (4–8 pairs),
- specific reversal of the ribs
- decrease or absence of chest movement during inhalation and exhalation,
- an increase in the sternum, its front,
- thickening of the bones and cartilage.
In addition, patients with a similar disorder, often of asthenic physique, are pale, with poorly developed muscles.
Increased severity of deformity occurs with age. At the same time, it seems from the outside that the chest is in a state of inhalation.
As for the danger of violation, it rarely provokes dysfunction of organs and systems. If, however, there are violations of the lungs, heart, they are not due to the curvature itself, and concomitant diseases, characteristics of the body.
Important! Most doctors consider keeled breast deformation solely as a cosmetic defect.
Recognizing the "chicken breast" in people under clothing is almost impossible. The exception is the strong manifestation of the curvature.
The diagnosis is established by a doctor already at the initial examination, since the chest is a wedge-shaped form in humans - a hallmark of pathology.
Next, to establish the type, nature, severity of curvature, The following diagnostic methods are used to assess the state of the internal organs and identify associated diseases:
- X-ray - to determine the type and severity of curvature of the chest,
- CT, MRI - to assess the state of the spinal column,
- spirography - assessment of the condition of the lungs,
- ECG - a study of the functioning of the heart.
Also, consultations of specialists from different areas are sometimes appointed: orthopedist, cardiologist, neurologist, pulmonologist.
How to correct keeled chest deformity in children and adults? Therapy depends on the severity of the curvature, associated diseases and the patient's age.
Reference. There are 2 directions of therapy: conservative and surgical.
Conservative treatment is not able to eliminate the defect or somehow affect the restoration of the physiological form of the breast.
But certain conservative techniques (massage, exercise therapy, breathing exercises, orthoses) allow to normalize blood circulation and metabolic processes, improve the functioning of the heart and lungs, strengthen the muscular corset, improve overall well-being. And this is important, given the particular physique of people who are diagnosed with pathology.
Surgical intervention is the main treatment for keel-like curvature.
This method of therapy is resorted to in several cases:
- the urgent need of the patient to eliminate the defect,
- the presence of 3 degrees of curvature, which is accompanied by violations of the internal organs or there is a threat to their development.
There are several methods of surgical intervention. In more detail we will talk about them further.
The peculiarity of the treatment of the breast fin in a child is that with the timely detection of a defect it is possible to do without surgery.
The body of the child is not yet formed. And experts noted that in childhood and adolescence the pressure on the chest contributes to the acquisition of its normal form.
Given this feature, with the aim of correcting curvature in children, the following methods are prescribed:
- Orthosis - a kind of corset, made individually. The therapeutic effect is based on the pressure on the deformed part of the breast. With constant use, there is a gradual elimination of the curvature and improvement in appearance.
- Marcello Ferre Dynamic Compression System - the device consists of a metal plate, a supporting mechanism and a device for measuring pressure. The system accurately measures the pressure and fixation, which helps to correct the curvature and prevent damage to the skin.
Orthopedic devices complement exercise therapy and massage, which will increase the effectiveness of treatment.
Adults are prescribed either a maintenance body in good physical shape, conservative treatment (does not eliminate the deformity), or surgery, which can eliminate the defect.
If the operation is contraindicated, and the patient is dissatisfied with their appearance, experts recommend the following methods:
- for women - correct the breast with silicone breast implants,
- to men - do sports and pump up the chest muscles.
These methods will not eliminate the deformation, but will make it less noticeable.
Surgical intervention is an effective way to correct the curvature.
There are two methods of operation:
- Ambronson technique - minimally invasive surgery, during which the doctor places special plates on the ribs. It turns out something similar to the rim on the barrel. This design fixes and holds the chest in the correct position. After 2–4 years, the curvature is eliminated and the plates are removed.
- Ravych method - performed incision, removal of costal cartilage, stitching the remaining perchondrium. In this way, the gaps between the ribs are reduced, the chest becomes physiological.
Less commonly, surgery is performed according to the Kondrashin method and according to the method of Timoschenko.
The Kondrashin technique involves performing a transverse sternotomy with removal of the deformity area and movement of the ribs.
Timoschenko’s surgery involves removing the cartilage of the ribs and installing a metal structure to correct the shape of the chest.
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Keel ribcage - this is the protrusion of the sternum, ribs and costal cartilage forward in the form of a wedge. Many believe that this deformation, popularly called “chicken breast”, can be corrected independently by various exercises. However, the experience of experts shows that the restoration of the correct shape of the chest with the help of therapeutic breathing exercises and fixing patches are usually ineffective. The most effective method of treatment is surgery. And do not be afraid. Today, modern medicine has advanced in this direction, which is an opportunity to correct this deficiency in a short time.
Well-known specialist, Ph.D., thoracic surgeon, Kuzmichev Vladimir Aleksandrovich He kindly agreed to answer our questions.
- Why is the keeled thorax called precisely keeled?
Everything is quite simple. It is called so because it is keeled. And the shape of the chest resembles the shape of an inverted boat. As you know, the boat has a keel. Birds have a similar keeled bone. That is why she got this name.
- What are the causes of this strain?
These are exclusively genetic factors. They are associated with impaired growth of costal cartilage. It does not fit in the chest and protrudes forward with the sternum.
- Is this disease inherited?
In most cases, this is a hereditary defect, that is, congenital. But the pathology is not immediately noticeable, it develops and progresses over several years.
- Does it negatively affect human health?
Keel-shaped deformation is a purely aesthetic deformation. Therefore, it has virtually no effect on health. However, due to the reflection of connective tissue problems, as well as due to the growth of cartilage, in the future there may be heart problems. But it is rather not the result of a strain, but a concomitant development. Also, the deformation of the chest can affect the state of the spine. Quite often, these patients have a round back. But, in this case, it is difficult to say whether this is a single violation of the formation of the skeleton or the result of deformation of the chest. There is no single glance here.
Thus, in many ways the keeled shape of the breast is only a cosmetic defect. To recognize a person with such a problem is very difficult: under the clothing, the keel is practically not contoured, except in the case of extreme severity.
- At what age does this deformation occur?
Keel-like chest deformity, like other deformities of the sternum, occurs predominantly at an early age. In the period of intensive growth of the body, at about 13-14 years old there is an increase. And by the age of 20, the full formation of the chest, including deformations, takes place.
- Is it possible to cure keeled deformity in early childhood with the help of massages and exercises?
No, unfortunately, this treatment is a myth. Oddly enough to hear about it. The question arises: “How is it possible to influence bones with the help of chaotic hand movements?” Such a method has not yet been revealed in modern medicine.
- Well, and what conservative methods of treatment exist today? Is it possible to avoid surgery?
Of course, with timely diagnosis, you can do without surgery. Over time, doctors began to notice that in adolescence, pressure on the keel contributes to the formation of the normal position of the chest. Therefore, it is worth noting orthoses (a device resembling a corset) and a more modern method of conservative correction - dynamic compression system which was developed and quite effectively used by the pediatric surgeon Marcelo Ferre (Marcelo Martinez Ferro, Argentina). Its advantage is that such a system allows a very metered exercise of pressure, while avoiding unpleasant consequences, such as skin damage, in this area.
Thus, the sooner the patient goes to the doctor, the better. Since in childhood the bones are soft and the chest is not fully formed, which allows you to direct its growth in the right direction.
- And if we talk about the operational methods of treating chicken breasts?
There are deformities that can only be corrected surgically, for example, the transverse carina (pectus arcuatum), which occurs as a result of early ossification of the sternum.
That is, if the deformity is at an advanced stage, the treatment is carried out only surgically. There are several methods. The first is Ravych operation. In this case, a large incision is made with transverse or vertical resection of cartilage. This method gives a good aesthetic result. The overhang is not reduced, but the chest does not expand. For patients with keeled breasts, a narrowed chest is usually characteristic.
In 2004, the Argentine surgeon Horatio Abramson (Horacio Abramson) developed a method mini-invasive keeled deformity treatment. The operation is almost the same as the Nass operation, which is applicable to the treatment of a funnel chest. This method involves the filing of special plates to the edges on the sides. Next, the axillary canal is made above the chest ribs, after which a plate is held, which is fixed to the other plates already fixed in this place. It turns out something like a "rim of the barrel", holding the chest in the desired position. With this plate the patient walks for three years. This period of time allows you to reshape the chest. In addition, it is not only the keel that is corrected, the thorax acquires a more natural wide shape. The complement to this method can be a thoracoscopic effect on cartilage.
Not infrequently coarse keeled deformity is combined with Marfan syndrome. Therefore, it is imperative to see a heart surgeon for a possible treatment of heart disease.
- Who faces this problem more often, men or women?
According to statistics, keeled chest deformity in men is much more common than in women. We are treated by those and other patients.
- If the chest does not cause any inconvenience, but still brings discomfort in an aesthetic sense, what will you advise?
Of course, a person can come to terms with his appearance, without attracting attention to it. If he does not get hung up on his problem, but, on the contrary, emphasizes his other virtues and abilities, he will be comfortable in his body. You need to love yourself the way you are. People are different, and this is what makes us interesting, different from each other personalities.
In the case when a person is still unable to come to terms with this, you can use the following methods. The girl can adjust the shape of the breast using silicone implants. A man is enough to go to the gym, in order to build muscle, thereby making the keel less noticeable.
- Is there a difference in the treatment of this problem in Russia and abroad?
Unfortunately, we are lagging behind in development in this direction. In Russia, they have just started to make orthoses for the keeled chest. And the use of the Ferret dynamic system in Russia is not registered at all. The patient has to order them abroad. There are also no modern plates for the operation of Abramson. However, this does not mean that such operations are not carried out with us. On the contrary, they are practiced, and still quite successfully, although with new plates their implementation would be easier.
Vladimir Alexandrovich, thank you very much for the conversation! Good luck in your work!
Sign up for a consultation with V. Kuzmichev. You can call:
+7 (499) 250-33-43, (499) 250-27-84. Full-time reception is conducted in Moscow.
Read more about keeled chest deformities >>
What is the chest
First of all, the chest is a part of the body. It is necessary to ensure the safety of the cardiovascular system, respiratory organs, spinal cord and brain.
The chest consists of three parts:
- — curved ribs, usually 12 pairs with the same structure, but different in size. Of these, only 7 pairs are true, 2 false pairs, not attached to the sternum and free, having such a position due to muscles,
- — bones in frontcalled the sternum. It is responsible for the normal formation of the chest. In appearance it looks like a shield, convex on one side and concave on the other, inside. The sternum consists of their arms, body and xiphoid process,
- — vertebraebeing a pillar of the chest.
The upper border of the chest is at shoulder level, where the first pair of ribs originates. The lower boundary is without a characteristic line and looks like a pentagon. If you look from the side and back, the chest in the lumbar region ends.
Together, they are a strong place for the internal organs - the heart and lungs. The connecting elements are costal-vertebral and costal-sternal joints.
But muscle tissue is not the last place in ensuring mobility. The chest is mobile. Such a complex structure helps to take an active part in the respiratory process, expanding with inhalation and contracting with exhalation.
Chicken breast concept
The disease is in second place for congenital deformities of the breast. First place takes a funnel chest. Male sex is about 4 times more likely to be subjected to congenital anomalies. A quarter of patients overtake hereditary predisposition, in 15% of the pathology is accompanied with Marfan syndrome, scoliosis, heart disease, etc.
Squamic chest is a hereditary or acquired disease. Sometimes it is found together with a funnel-shaped deformation, therefore it is considered that they have the same nature of origin.
It has been established that there is a connection between the CDGK (keeled chest), the patient's physique, connective tissue. Such people are distinguished by their tall stature and asthenic physique.
Asthenic chest is a cell with a small diameter. It is narrow, stretched in length with delineated clavicle and ribs. And the edges are not horizontal, with a large gap between them. Formed obtuse angle between the neck and shoulders. Muscle tissue is not developed.
Marfan syndrome is a pathological change in connective tissue in conjunction with dolichostenomy or high growth, long arachnid fingers, lack of adipose tissue, articular hyper-mobility, problems of the cardiovascular system and health of the visual organs. Some patients have marfan syndrome with GDGK.
There are cases when heart defects and deformity of the spinal column occur.
As soon as the child is born, the deforming process of the chest is not noticeable, but as the growth increases, the disease becomes visible. Over time, a cosmetic defect of varying severity appears.
As a rule, these patients have no problems with breathing and blood circulation in the first years of life. The older the child becomes, the more shortness of breath, rapid fatigue, and increased heartbeat. Objective disturbances in the form of increased respiration, oxygen deficiency and reduced lung capacity are becoming a problem.
Diseases do not appear because of the very deformation of the sternum, but due to the peculiarities of the structure of the body.
- - when the sternum in the form of an arc is curved forward from below and closer to the middle, the ribs are turned inward,
- - Sternum oblique with forward and downward direction. The most bulging place is the bottom third.
The deformation may be symmetrical and asymmetrical, in which the sternum develops incorrectly and is bent along the axis.
Symptoms of the disease
Identify keeled chest can be visually. The chest changes shape, has a projection forward. Ribs 4 through 8 in these patients sink, and the edges of the rib arcs may have a reversal.
At the same time the sternum increases in size, and breathing becomes significantly less than the norm. If you look from the side or in the photo on the chest, it seems that the chest is in a constant breath.
Over time, the chest cell ossifies in the area of the cartilaginous areas of the ribs. For this reason, the chest frame becomes almost immobile, which affects the respiratory excursion, which decreases.
Because of this, respiratory functions deteriorate, pneumonia, respiratory diseases, and pulmonary pathologies appear.
Stages of the disease
- Age from birth to 7 years. During this period, the child's body functions are not impaired, there are no disturbing factors, the mental background is calm.
- Teenage period up to 15 years. Deformation increases and becomes noticeable. Breathing is normal, the work of the cardiovascular system does not suffer. An inferiority complex appears, an attempt to avoid crowded places, swimming pools and beaches.
- Pathology progression. Men after 25 years old complain of shortness of breath during physical exertion, weakness, disability, pain.
The final diagnosis is made after a medical examination, classification of the deformity and the stage of the disease. Be sure to be assigned x-rays in the lateral projection and CT.
If there are signs of heart and pulmonary insufficiency, then the patient should undergo spirography, ECG, Echo-KG and other diagnostics. It is necessary to receive consultations of narrow experts - the cardiologist, the pulmonologist.
When Marfan syndrome develops, the patient is sent for examination with the obligatory conclusion of narrow specialists.
What treatments are prescribed?
Many people who are not related to medicine are convinced that breast deformity can be corrected with exercise or breathing exercises. But this will not help.
Experts believe that the patient received a normal chest, the intervention of a surgeon is necessary. The remaining activities - exercises, etc. will only help to improve the physical condition and it is of great importance, especially for people with asthenic physique and pathologies of the cardiovascular system.
Before you begin treatment, you need to prioritize for optimal results. In each individual case, they are different.
For some, surgery is more important, so as not to experience psychological problems and not to lower self-esteem. For others, it is more important to undergo physical therapy and a therapeutic course. At an early stage of the disease, you can try a conservative method.
Apply massage, physiotherapy at home, taking anti-inflammatory drugs, analgesics. The task of traditional therapy is to improve the work of the circulatory system, metabolism, strengthen muscle tissue.
Since the keeled form of the breast does not manifest negative consequences and does not disrupt the functioning of the internal organs and systems of the person, there is not always evidence for surgery.
However, if the patient insists on eliminating a cosmetic defect, then doctors resort to this method.
Minimally invasive operation according to the method of Abramson
The most popular today. The surgeon makes only two small incisions of 3-4 cm on the side, then sews to the edges of the plate, and to them another plate straightening values. Such a construction of metal costs several years and after straightening the sternum and the disappearance of the keel-shaped form is removed.
Using the method of Mark Ravich
The classic option. The operation in this case is open.
An incision is made across under the mammary glands or pectoral muscles, cutting them off from the joints, and the rectus abdominis muscles are separated.
According to Ravich, rib cartilage resection is performed, the perchondrium is sutured, the distance between the ribs is reduced, and the breast itself is given a normal position.
When the deformity is severe, the doctor may apply a wedge-shaped sternotomy.
The postoperative period requires recovery and at this time it is recommended to undergo a massage, exercise therapy, physiotherapy.
When a patient is contraindicated in an operation or when he does not want to solve the problem in this way, the doctor considers the option of correcting the aesthetic perception of the body without interfering with the chest area.
For example, men are advised to pump up the chest muscles, and for the female to think about breast implantation. Of course, this has nothing to do with the elimination of the deformation, but makes it not so conspicuous.
For the past decades, some Russian surgeons in this field have been practicing Ferret compression system. But, it is effective only when the bones and cartilages are flexible. At the same time appoint the wearing of a special apparatus.
The problem is that this method has not yet been certified in our country and the patient must wear the device for several years. Children are given such treatment and the entire course is able to undergo only half of the patients.
Another of the drawbacks is a long contact with the skin, which over time becomes thinner and there is a strong pigmentation.
What are the defects of an acquired character
- Purulent processes in the lungs, osteomyelitis of the bones of the breast, empyema of the pleura, purulent abscess of the lungs leave their traces in the form of falling ribs and sternum, curvature of the spine.
- Fracture of the handle of the sternum or its body leads to the deformation of the entire chest. Curvature at the same time - this is rare, but there are fractures of the sternum or changes in the bone frame.
- The postoperative period after thoracoplasty threatens to relapse.
- The defeat of the internal organs diseases of a chronic nature - heart disease, ankylosing spondylitis, scoliosis.
- Rickets, syringomyelia are prerequisites for the deformation of the chest.
- Breast injury.
The price of treatment in Moscow
What costs are waiting for the treatment of chest deformity:
- reception of an orthopedist - 2,000 rubles.
- chest x-ray - 1 800 rub.
- CT scan - 5 100 rub.
- ECG - 800 rubles
- reception of the neurologist - 2 000 rub
- Cardiologist consultation - 2 100 rub.
- spirometry - 1,500 rubles.
- examination of the pulmonologist - 2 200 rubles.
- Consultation of a children's orthopedist - 2 100 rubles.
- thoracic surgeon consultation - 2 300 rub.
- surgical correction of the chest - 68 700 rubles.
Keeled chest - the second most common congenital deformity of the chest after the funnel chest. It is about 7% of the total number of violations of the shape of the anterior chest wall. Men suffer 4 times more often than women. Hereditary predisposition is detected in 26%, in 15% there is a combination with Marfan syndrome, congenital heart defects, scoliosis and other connective tissue diseases. Thoracic surgeons perform treatment of keel-shaped deformation of the chest, and in small localities that do not have thoracic centers, traumatologists and orthopedists.
Causes and pathogenesis
Keel-like thorax is a hereditary congenital malformation. In some cases, the joint inheritance of keel-shaped and funnel-shaped breasts is revealed; therefore, some researchers suggest a common nature and mechanism for the development of these anomalies. In addition, the relationship between the presence of CDGC, the physique of patients and the state of their connective tissue was reliably established. In most cases, patients with keeled chest deformity are tall and asthenic.
In some patients, chest pathology is combined with Marfan syndrome - a systemic disease caused by connective tissue pathology and including dolichostenomyelia (tall), arachnodactyly (elongated spider-like fingers), underdevelopment of fatty tissue, hypermobility of joints, disorders of the cardiovascular system and organs of vision. It may also be combined with congenital heart defects and scoliotic spinal deformity.
At birth, the chest anomaly is usually subtle, but as it grows, the deformity progresses, and over time a cosmetic defect forms, the severity of which can vary greatly. Functional disorders of the respiratory and circulatory organs in the first years of life are not pronounced. Some older children complain of shortness of breath, fatigue and palpitations during intense exercise. At the same time objective violations can be detected: an increase in the minute volume of respiration, a decrease in the coefficient of oxygen consumption and lung capacity.
These violations, as a rule, are not due to the deformation itself, but related features (asthenic body type, narrowed chest, congenital heart disease). Currently, most experts believe that the keeled chest itself does not entail negative consequences in the form of disruption of the heart and lungs and is a purely cosmetic defect.
There are a large number of classifications of CDGK, but the most complete and practically significant option is Fokin and Bairov:
- Costal type. The curvature of the sternum is absent or weakly expressed and is of a rotational nature. The deformity is formed due to the bending of the costal cartilages anteriorly.
- Manubriostal type. The handle of the sternum along with 2-3 articular costal cartilages is curved anteriorly, and the body of the sternum with the xiphoid process is displaced posteriorly.
- Corp. rest type There are two options. The first one - the sternum is arcuately curved forward in the lower and middle third, the costal cartilages are curved medially. The second - the sternum obliquely is directed forward and downwards and is maximally protruded in the lower third.
Both symmetric and asymmetric deformations can be observed. In the second case, due to the incorrect development of the ribs, the sternum is curved along the axis.
The shape of the chest is broken due to the protruding sternum, the front part of the chest stands forward. In most patients, the cartilaginous parts of the IV-VIII ribs sink down on one or two sides. Usually, a characteristic reversal of the edges of the rib arcs is revealed. Thorax significantly increased in the anteroposterior direction, changes in the anteroposterior size during respiratory excursions are reduced compared with the norm or are practically absent. From the side it looks as if the chest is constantly in a state of inhalation.
The diagnosis is made on the basis of the inspection data, to determine the type of deformity and the severity of the changes, a chest X-ray in the lateral projection and computed tomography are prescribed. If there is a suspicion of pathology on the part of the heart and lungs, the necessary studies are carried out: spirography, ECG, Echo-KG, etc., consultations of a cardiologist and a pulmonologist are appointed. In Marfan syndrome, a comprehensive examination is shown, which includes consultations with the orthopedist, cardiologist, pulmonologist, ophthalmologist, and neurologist.
Among people who are far from medicine, it is widely believed that keeled chest deformity can be corrected with the help of physical therapy, breathing exercises and exercise. Unfortunately, experts have a different opinion - to restore the normal shape of the chest can only be using surgical techniques. All other methods only improve the physical form of the patient (which is also important, especially with severe asthenia, the presence of connective tissue diseases and pathology of the cardiovascular system).
Based on the foregoing, and also from the fact that the keeled chest is for the most part a purely cosmetic defect, it is clear that an optimal result in the treatment of this pathology can be achieved only by determining the priorities that have the greatest value for a particular patient. With the same type and degree of deformity for one patient, it will be more important to restore the normal psychological background and self-esteem, having performed the operation, for the other - to improve the general condition of the body by prescribing a course of exercise therapy and general strengthening treatment.
Since, unlike the funnel-shaped, keeled-shaped deformation of the chest does not have a clear negative impact on the functioning of the organs and systems of the patient, the only indication for surgical correction is the urgent need of the patient to eliminate the cosmetic defect. In this case, doctors recommend to resort to surgical treatment only in extreme cases. There are two main surgical techniques for treating the keeled chest: minimally invasive intervention using the Abramson method and open-access surgery using the Mark Ravitch method.
During surgical intervention according to Ravich, the doctor performs a cross-section under the breast / pectoral muscles and cuts the pectoral muscles and rectus muscles of the abdomen from the attachment points. Then it resects the costal cartilage and stitches the remaining pericarparial, reducing the intercostal spaces and bringing the sternum in a physiological position. In case of severe deformity, wedge-shaped sternotomy is additionally performed.
Open surgical interventions using the Kondrashin method (transverse sternotomy with resection of the deformity area and relocation of the ribs), as well as metalochernonechondroplasty by Timoschenko, are less commonly used. Currently, along with the listed traditional methods, the minimally invasive Abramson operation is becoming increasingly popular. When using this technique, the doctor makes two incisions 3-4 cm long on the sides, hems the plate to the ribs and attaches another one to these plates - straightening. Metal structures are removed after a few years, after the complete correction of keeled deformity and re-formation of the chest.
If there are contraindications to the operation, as well as in cases when the patient is dissatisfied with the appearance of his chest, but does not agree to the listed surgical interventions, methods are proposed to correct the aesthetic perception of the body without correcting the shape of the chest. Men are recommended to pump up the pectoral muscles, and for women - to install silicone breast implants. This does not eliminate the deformation, but makes it less noticeable.
In recent years, a number of domestic thoracic surgeons have offered patients non-surgical correction using the Ferre compression system. This technique can be used only at an early age, when the bones and cartilage are still quite flexible, and involves the wearing of a special apparatus. It is worth noting that this system has not yet been certified in Russia, and the devices have to be ordered abroad. Another disadvantage of this method is the need to wear the device for several years. The children tolerate the procedure quite hard, and only half of the patients “reach” the completion of the course of treatment. In addition, due to prolonged pressure, the skin in the region of the sternum may become thinner and become excessively pigmented.
What it is
This pathology is an abnormal development of the bones of the chest. Very rarely, the disease disrupts the work of the internal organs, more often it is an exclusively cosmetic defect.
Due to the fact that the sternum comes forward, this disease also received the name "chicken breast". Code for the International Classification of Diseases [mkb 10]. Anomaly is congenital, transmitted genetically. Its manifestations become more pronounced during the period of intensive human growth, i.e. in adolescence. The final formation of the defect usually ends by the age of majority.
According to statistics, the disease is more common in men than in women. Together with it, patients often diagnose Marfan syndrome, spinal curvature, heart defects.
The main causative factor of this pathology is a hereditary predisposition. But it is possible that the disease is also associated with rickets in childhood. It is assumed that excessive softness of the bone tissue does not withstand the load when the body is in an upright position, which leads to a gradual deformation. Chicken breast with rickets is quite common, so the treatment of a defect in this diagnosis should include vitamin therapy.
Keel deformity in children
The disease is detected most often in early childhood. Но в некоторых случаях симптомы малозаметны, поэтому она диагностируется в период интенсивного роста организма – в 11-13 лет.
The deterioration of the respiratory system, blood circulation, heart in the first years of the child are missing. But the deformity in adolescents is often accompanied by:
- shortness of breath
- quick physical and mental fatigue,
All this manifests itself during vigorous physical activity. If symptoms bother without physical exertion, urgent surgical intervention is required. Experts explain this not by the features of the pathology, but by the fact that the patients have asthenic body type: general leanness, narrow sternum, poorly developed muscles.
The external defect is disturbing and often an obstacle to the normal socialization of the child. At school, children are subjected to ridicule, which leads to mental disorders: isolation, shyness, timidity, and sometimes aggression.
Pathology is characterized by a significant extension of the anterior surface of the sternum relative to the norm. Her form is in an elevated state, as if the person is breathing in air. It practically does not change during the respiratory excursion. Its middle part protrudes forward, and the edges at the edges sink down, the sternum takes on the appearance of the keel of a watercraft. Hence the name of the deformation.
The costal arches from the 4th to the 8th row are mainly affected, there is a reversal of their edges. The sternum is enlarged.
Deformation can not be corrected with the help of exercise. However, this treatment will help make the chest more pliable and improve the patient’s physical fitness.
Since when keeled strain very often there is muscle weakness, exercise therapy will help get rid of the problem. This method of treatment is auxiliary and it is recommended to carry it out at the initial stage of the development of the disease, as well as after surgical correction of the chest.
For treatment to be effective, it must be agreed with a specialist. Since For each patient, individual techniques, motor regimen, dosages, intensity of exercise based on general health and associated symptoms are selected.
If the deformation negatively affects the functioning of the internal organs and the patient is worried about tachycardia, autonomic disorders, then exercise therapy should be carried out with caution.
After the patient has selected an individual set of exercises, to achieve a pronounced therapeutic effect, exercise therapy is recommended to be combined with proper nutrition, various breathing techniques, swimming, massage, and physiotherapy.
Ferre Dynamic Compression System
The developer of the compression system is a pediatric surgeon - Marcelo Ferre, who has over 20 years of medical practice. The system was developed to eliminate the asymmetry of the sternum and correct the curvature. It is made according to patient parameters. Consists of:
- an aluminum alloy metal plate that fits under the protruding portion of the sternum,
- supporting mechanism that is attached to the back,
- pressure measuring device that regulates the force of fixation and prevents skin damage.
The system is effective for use in children or as an integrated therapy. If a patient is more than 20 years old, then it is almost impossible to achieve a pronounced effect using one technique. Therapy is well tolerated by patients and does not cause significant discomfort.
In the process of curvature correction, periodic adjustment of pressure is required. The duration of treatment is selected individually. If therapy is started at the very beginning of the development of the disease, then there is an opportunity to avoid surgery.
Orthoses is a complex name for medical devices designed to correct the anatomical features of the musculoskeletal system. When keeled sternum deformity this device is a corset, fixing in the correct anatomical position.
The therapeutic effect is achieved by the compression of the protruding part of the sternum. With constant wear, these devices gradually eliminate the curvature and improve appearance. Like the Ferret system, orthoses require periodic adjustment of pressure and increased fixation.
So that the created compression does not cause discomfort, such constructions provide for effective unlockable systems that allow you to easily adjust the tension yourself without any assistance.
The chest orthosis is made individually, taking into account the parameters of the protruding portion and the degree of curvature. For the treatment of keeled deformity, devices are used in the form of a folding hoop, on which metal plates are fixed, which have a therapeutic effect. On the other hand, there is also a plate that softens the pressure.
Orthopedic corsets have contraindications for wearing:
- systematic cough, bronchial asthma,
- contact sports,
- dermatitis, eczema, inflammation of the skin,
- problems with the bloodstream, vascular system (for example, varicose veins),
- first days of the postoperative period, etc.
Treatment with orthoses will bring results if it is started in early childhood or in adolescence, when the cartilage and bone tissues are flexible and easily exposed. If the curvature is strongly pronounced, then it is difficult to achieve the desired effect. It is necessary to wear devices constantly (at least 12 hours a day) and, perhaps, in six months or a year, the bone elements of the sternum will acquire a normal anatomical shape.
This method of treatment remains the most effective. There are several ways to correct the curvature, the main of which are: the methods of Ravych, Abramson, Nass, Kondrashin, Timoschenko.
It is considered a minimally invasive operation. It is practiced often, it is recommended for patients up to 20 years. It is performed under general anesthesia. On the lateral surface of the chest, the surgeon makes 2 small incisions (3-4 cm). Then through a PVC tube fixes on the ribs 2 small metal correction plates.
After that, a larger plate is fixed between them, straightening, with the help of adjustable screws (such fastening makes it possible to correct the pressure force). It is located perpendicular to the two small ones. Then stitches. So pressure is created inside the chest that promotes proper bone growth.
A few years (2-4 years) after the complete correction of the curvature of the metal structure is removed. The invasiveness of this operation is low. The duration of inpatient stay in a medical institution does not exceed 5 days. After 2 weeks, the patient can return to the usual way of life, but eliminating some physical activity. Stitches and scars after surgery are almost invisible.
It is considered a traumatic method of correction. Used rarely. During surgery, the surgeon makes a cross-section under the mammary glands and cuts off the muscle tissue of the abdomen and chest from the points of attachment. Then a segmental excision of the costal cartilages and stitching of the remaining perchondrium is performed. So intercostal spaces are reduced, the chest is displayed in a normal physiological position.
If the defect is strongly pronounced, then a corrective sternotomy is additionally performed. After surgery, a long recovery period is required, besides, pronounced postoperative scars and scars remain on the skin.
Carried out through a vertical incision on the front surface of the sternum. Provides a wedge resection of deformed cartilage at the site of transition into the bone tissue, parasternal chondrotomy. After which the wedge-shaped sternotomy is performed, the urinary process intersects. In the end, the rib cartilages in the resection area are stitched, stitched onto the sternum. Thanks to this operation, the chest is in a state of hypercorrection.
In boys, one horizontal incision is made under the pectoral muscles, in girls - 2, skin is exfoliated in the area of curvature. Then, the pectoral muscles are separated from the curved costal cartilages, and the latter are removed, preserving the sheath. So edge becomes shorter by several cm.
At the top of the curvature, a sternotomy is performed and a metal curved plate is attached to the ribs, repeating the normal shape of the chest. After a few months, the metal structure is removed.
Since keeled deformity is often combined with a funnel, the Nass method is used to treat the latter, it has similarities with the Abramson method.
The procedure is a minimally invasive intervention. It is performed under general anesthesia. It was developed by Donald Nass, a pediatric thoracic surgeon in 1987. The results of treatment with this method have impressive results - approximately 98% of patients manage to eliminate the defect, the rest have residual curvature associated with insufficient elasticity of the bone tissue.
The funnel-shaped recess is compensated for by a curved metal plate, which has a concave surface facing up. It is fixed on the ribs with long absorbable suture materials, steel wire or other fixatives.
The operation is allowed to patients of any age, but taking into account all contraindications. Sometimes complications are possible: hemothorax, hydrothorax, plate rejection or its displacement, pneumothorax.
The treatment of keeled deformity is a complex and lengthy process. At the initial stages of the development of the disease, the use of orthopedic constructions is allowed; at more severe stages, only surgery will be effective.
The chest is a kind of skeleton of muscles and bones. Its main task is to protect the internal organs of the upper torso. It is now established that the deformation of the chest has a negative effect on the heart, lungs and other organs. This pathology entails disruptions in the normal functioning of various systems.
All possible variants of this pathology are divided into two main groups. As mentioned earlier, the chest deformity can be both congenital (dysplastic) and acquired. The latter are much more common. Their development often occurs under the influence of the following factors:
- Bone tuberculosis.
- Severe injuries and burns of certain areas of the sternum.
- Chronic lung disease.
Any chest deformity (congenital) implies the presence of serious abnormalities or underdevelopment of the following areas:
- Shoulder blades
- The breasts.
- Chest muscles.
Less commonly, the most severe chest deformity occurs. The reasons lie in the presence of a significant disturbance in the development of bone structures.
Violations are divided into forms depending on the location of the pathology. There are deviations of the following walls:
Deformations can be very diverse. In some cases, this is a slightly noticeable cosmetic defect, while in others it is an incredibly gross apparent pathology. The latter most often causes significant disturbances in the functioning of the lungs and heart.
Funnel chest deformity
This pathology is accompanied by a noticeable recession of individual zones. These are, in particular, the anterior sections of the ribs, cartilage or sternum. This is a fairly common developmental defect. Funnel deformity of the chest often occurs due to the presence of serious genetic changes in the structure of cartilage and connective tissues.
Clinical picture at a younger age
This pathology very often becomes the cause of other ailments. Chest deformity in children occurs during their active growth. During this period, changes in the shape of the bones occur. In particular, this refers to the spine. Also, very often there are changes in the location of internal organs and violations in their work. Chest deformity in children is accompanied by multiple malformations. With regard to such cases, in the history of (family) can reveal several similar pathologies that are among the closest relatives. This disease is characterized by a clear retraction of the sternum. As a rule, its entire cavity is significantly reduced. If a patient has a pronounced funnel-shaped deformity of the chest (its treatment is quite complicated), then in this case, the curvature of the spine is inevitable. There is a significant displacement of the heart, begin serious problems in the work of the lungs. Often there are dangerous changes in venous or blood pressure.
Stage of the disease
Modern experts in traumatology distinguish them from all three:
- First degree In this case, the depth of the funnel does not exceed 2 cm. At the same time, the heart does not shift.
- Second degree It is characterized by the following depth of the funnel: 2-4 cm. At the same time, the heart is displaced (up to 3 cm).
- Third degree In this case, the depth of the funnel - from 4 cm and more. At the same time, the displacement of the heart exceeds 3 cm.
Features of the disease at an early age
In most infants, the presence of such a pathology is almost imperceptible. Only during inhalation there is a significant dropping of the ribs and sternum. Pathology becomes more pronounced as the child grows. In the future, it reaches its maximum. Very often, these children begin to lag significantly in physical development. Also, in most cases, serious autonomic disorders and colds become their companions.
With the subsequent development of deformity, the chest becomes fixed. The depth of the funnel can increase to 8 cm. The child begins to develop scoliosis. In some cases, thoracic kyphosis appears. There is a decrease in respiratory excursion of about three to four times, if compared with age norms. There are serious violations in the work of the cardiovascular and respiratory systems. Many children suffering from this pathology are asthenic. In most cases, the vital capacity of the lungs is reduced by 30%. Often marked manifestations of cardiac and respiratory failure. Gas exchange in the blood is very difficult. Children often complain of fatigue and pain behind the sternum.
This procedure consists of a whole complex of various studies. These include: radiography of the lungs, ECG and echocardiography. Focusing on the results of the above manipulations, experts can determine the extent of changes in the activity of the heart and lungs.
Features of therapy
At present, it has been proven that the use of modern conservative methods in the presence of this pathology is extremely inefficient. If a child is diagnosed with severe chest deformity, an operation to reconstruct it helps to create normal conditions for the functioning of internal organs. This is a very serious surgical intervention. Usually, the operation is planned when the child is already six years old. If chest deformity is detected, exercise will not contribute to the complete deliverance of the patient from the pathology. Generally recommend the following:
- Hyperbaric oxygenation.
- Acupressure chest massage.
- Special physical therapy.
- Respiratory gymnastics.
All the above exercises must be performed. This is necessary in order to prevent the possible progression of pathology.
Keel-shaped chest deformity
Basically, this pathology is caused by the presence of excessive proliferation of the main costal cartilages. In this case, the sternum of the patient always comes forward. This is due to the fact that, as a rule, the growth of cartilage from 5 to 7 ribs occurs. For this reason, the chest takes the shape of a keel. In the presence of such a pathology often increases its anteroposterior size. The child grows and the deformation becomes more and more noticeable. There is a visible cosmetic defect. At this stage, the spine and all internal organs suffer slightly. The heart takes a teardrop shape. Many patients have the following symptoms:
- Fast fatiguability.
- Palpitations (with physical exertion).
- Severe shortness of breath.
If a child has severe keeled chest deformity, then surgical intervention is prescribed when disturbances in the functioning of the internal organs appear. Surgical manipulations are not shown to those children who have not yet reached the age of five.
In practice, there are various cases of developmental disorders of the area in question. One of them is considered emphysematous chest. It is about increasing the airiness of the lung tissue. With this pathology, the shape of the chest gradually changes. This is due to the fact that the disease is accompanied by an increase in the lungs. There is a change in the anteroposterior size of the chest. It gradually increases. The chest of the patient becomes rounded.
Features of a paralytic form
This pathology is usually found in the presence of diseases of the pleura and lungs (chronic). В этом случае происходит уменьшение органа.The same happens with the lateral and anteroposterior size of the chest. At the same time there is a dropping of intercostal spaces. Accordingly, it becomes difficult for patients to breathe. The scapulae and the clavicle are also clearly visible. This is due to the fact that their location relative to the sternum and ribs varies. The symmetry of the movements is broken.
Most often, this pathology is observed in patients with a rare disease. It's about syringomyelia. With this disease, cavities appear in the spinal cord. Pathology is characterized by a change in the composition of bones. This is due to the fact that calcium salts are leached from them. Bones can be deformed as they become less rigid. The disease is accompanied by a navicular indentation of the chest.
The appointment of optimal therapy
Most of these acquired pathologies are the result of chronic diseases. They do not pose a threat to the lives of patients. If the patient has congenital deformity of the chest, the treatment can also be successful. In this case, conservative methods are ineffective. Surgical intervention is prescribed when there is a violation in the chest organs. It can also be shown if there is a pronounced cosmetic defect.
Features of reconstruction
During the procedure, the sunken parts return to their places. They are fixed mechanically. In the presence of keeled deformity, the rib cartilage is truncated. In the case of this pathology, surgical interventions are performed less frequently. Currently, there are new treatments. In the area that needs correction, a magnet is implanted. The second is arranged in such a way that their interaction is aimed at correcting the defect. Some cosmetic problems are masked by implantation of silicone over the deformation site.
What is chest deformity?
Human thorax is a kind of shield that supports and protects vital organs. It also represents the musculoskeletal skeleton, to which the ribs are attached. If a situation arises when a child has a chest deformity, then this entails serious consequences. Deformation can be either congenital or acquired. It negatively affects the work of all internal organs. It is worth recalling that the chest is designed to protect the heart, lungs, liver, spleen. And if a violation occurs in one organ, then the entire life support system suffers.
Congenital deformity of the chest is also called dysplastic. It is important to know that such forms are much more common than acquired. Violations of the bone structures, their formation in the womb, anomalies of the spinal column occur. Most often, changes are noted in the front of the child’s chest. Acquired deformities arise from a variety of diseases that can affect a person at any age.
Types of disease
All violations of the chest, which are known to specialists, can be combined into two large groups. These are deformations such as congenital and acquired. But within each group there is a classification. Also, depending on the location, in a child, the deformation of the chest has several forms. It is believed that it can be front, side and rear. According to the degree of violation, the illness is often implicitly pronounced, even almost imperceptible until the appearance of serious pathologies affecting the work of the heart and lungs.
Congenital deformities are divided into the following types:
- Funnel-shaped, in the common people, this type of disturbance is called the "shoemaker's chest."
- Keel-shaped, or "chicken breast."
Acquired violations are divided into:
It should be noted that in cases of congenital deformities of the chest, most often violations occur on its front wall. If this is an acquired deformation, then both lateral and posterior surfaces may be disturbed. You also need to know that if there is a congenital deformity of the chest in a child, its treatment is most often surgical.
The causes of the disease
When a child gets sick, parents try to find out the causes of the disease. In such cases, it is better to prevent the disease than to treat it for a long time. To find out why a chest deformity occurs in a child, it is necessary to understand the etiology of the disease.
As already known, the deformation is congenital and acquired. Causes of congenital deformity:
- Genetic predisposition (heredity).
- Underdevelopment of bone tissue in the womb.
This is one of the most common causes of congenital deformity. You should also be aware that the underdevelopment of the baby’s bone tissue can occur because the mother has had an infectious disease in the first trimester of pregnancy. On the congenital deformity of the chest can be influenced by the lifestyle of the expectant mother, insufficient receipt of the embryo nutrients, the presence of bad habits in the parent. The latter include alcohol, tobacco smoking and the use of narcotic substances, as well as an important factor is the late request for help from specialists.
Causes of acquired disorders
Why does an acquired chest deformity appear in a child? The reasons that provoke it are listed below:
- Diseases of the musculoskeletal system.
- Inflammatory and purulent diseases of soft tissues.
- Various injuries.
- Unsuccessful surgery.
- Excessive exercise.
- Metabolic disease.
- Anomalies of bone tissue.
- Down syndrome.
- Ankylosing spondylitis.
- Inflammatory diseases.
- Syndrome Wife.
All these diseases lead to serious consequences, and as a result they deform the chest.
Occurrence of the disease
If a child has a chest deformity, and it manifested itself at an early age, doctors distinguish several theories of its formation. One of them says that the ribs and cartilage develops faster than the sternum, and because of this they displace it. Other authors are of the opinion that the violations were caused by intrauterine pressure, which displaced the back wall of the ribs. Anomalies of the diaphragm with the addition of rickets also belong to this theory. Another theory says that funnel-shaped deformity arose due to pathologies of connective tissues.
Also, the deformation can manifest itself in several defects, both not too pronounced and pronounced. It all depends on the factors acting on it:
- Sternum having a degree of posterior angulation.
- Rib cartilage having a degree of posterior angulation at its attachment to the ribs.
Do not forget that the disease can be burdened by various anomalies of the diaphragm, which complicates treatment. Also, doctors have several methods that help determine the severity of the disease. This is a quantitative calculation of the distance from the sternum to the ribs.
Keel deformity in a child
According to the degree of prevalence of deformations, keeled is in second place. It occurs when a large and rapid growth of costal cartilage. The shape of the sternum becomes like a bird's chest, because it protrudes forward. Many parents have questions about what is deformation of the chest in a child? Causes and treatment (photos of patients are presented in this article) will be discussed in detail.
The keel-shaped deformity in a child becomes more noticeable with age and develops as a pronounced pathology. But it is worth noting that with such disorders of the musculoskeletal system, internal organs do not suffer. Symptoms such as shortness of breath and palpitations may occur. As for the spine, it is not subject to change. Most often, the disease affects boys. Sometimes violations are asymmetrical in nature, with indentation on the one hand and bulging on the other.
Causes of illness
The etiology of such a violation is not entirely clear, as is the case with funnel deformity. It is believed that the cause is excessive growth of osteochondral cartilage. In turn, it all depends on heredity and genetics. If relatives had such a disease, then it is possible that it was transmitted to the child. It is important to remember: if a child has a chest deformity, how to fix this problem will be prompted only by experienced specialists.
Another opinion is that the deformity is caused by scoliosis and congenital heart disease, as well as anomalies of the connective tissue. Most often, doctors divide this disease into three types:
- The sternum and ribs have symmetry, and the xiphoid process moves downwards.
- The sternum is shifted down and forward, there is a protrusion. The ribs in this case are bent.
- Rib cartilages bend forward, but there are no violations of the sternum.
Symptoms of the disease appear already in adolescence, but they are slightly pronounced. Sometimes signs are brightly shown at heavy physical activities. Also, the disease contributes to the development of asthma.
The child has a chest deformity: how to treat?
The methods of treatment are varied - it all depends on the degree and type of deformity, as well as on whether there are irregularities in the cardiovascular and respiratory systems. If the violations are minor, then you can choose a conservative treatment. Parents who are concerned about the health of their children often ask the specialist: “If a child has chest deformity, what to do?” In such cases, it is important to listen to the opinion of doctors and not make hasty decisions. After all, the child's body is still developing, and with the wrong treatment, the clinical picture will worsen. In certain cases, doctors recommend surgery. Here the diagnosis of the disease plays a special role.
Thoracic deformity in children: home treatment
If the disease does not require surgical intervention, then conservative methods of treatment will work fine. So, parents at home can independently help their child. This treatment includes the following actions:
- physiotherapy - moderate exercise and development of bone tissue will help when there is a slight deformation of the chest in a child,
- massage treatment by a specialist,
- physiotherapy, which prescribes a doctor,
- Swimming is an excellent tool for developing the musculoskeletal system and raising the mood.
If you follow and comply with all the recommendations of doctors, then at home, parents will be able to develop their child, give him a chance to be healthy and stop the disease.