Options for children with chest wall deformities
Chest wall deformities, or irregularly shaped chests, are common birth defects appearing in about one out of 300-500 children in the United States. These defects can cause shortness of breath, decreased stamina and heart/lung function issues, which can limit a child’s ability to participate in activities with their peers.
In addition to the physiological effects, the condition can have significant psychological impacts. Chest wall deformities, which can be barely visible at birth, often become more apparent during rapid growth spurts leading to adolescence. During the teenage years, these children may be acutely aware of the shape of their chests and suffer from reduced body image and self-esteem. Many teenagers with chest wall deformities feel unwilling to be seen without a shirt while swimming or to participate in sports or social activities. Sadly, many avoid sports altogether because of their appearance.
The cause for chest wall deformities is neither known nor understood, but thanks to advances in modern medicine, there are many ways to treat chest wall deformities — both surgically and non-surgically — and improve children’s lives, both physically and emotionally. In the summer of 2018, Kalispell Regional Healthcare’s Pediatric Surgery department launched a chest wall deformity clinic to diagnose and treat children with chest wall deformities.
“There is no other clinic offering this type of treatment in Montana,” said pediatric surgeon Dr. Gavin Falk, “Montana’s children have had to travel out of state to Seattle or Salt Lake City to be seen by a chest wall deformity specialist. Now we offer the same level of expertise and treatment options.”
17-year-old Jakeb Bushman from Wolf Point, MT, was one of the first patients to visit the clinic. He suffered from pectus excavatum, where the chest appears sunken or caved in, caused by an inward growth of the breastbone and portions of the ribs. Also called “funnel chest”, pectus excavatum is the most common chest wall deformity, and is more prevalent in boys than girls. Children with pectus excavatum often experience chest pain, exercise intolerance or shortness of breath. Jakob opted for surgery.
“His condition prevented him from being as active as he would like to be,” said pediatric surgeon Dr. Federico Seifarth, “We performed a minimally invasive NUSS procedure which led to immediate correction.”
Named after Dr. Donald Nuss, the physician who invented the procedure in 1987, the surgery involves placement of a metal “Nuss” bar in the chest, which immediately elevates the sternum. The bar will be removed in another surgery after about three years.
14-year-old Salem Steward’s condition was the opposite of Jakeb’s. Instead of pectus excavatum, where the chest is sunken, he suffered from pectus carinatum where the chest protrudes out. Pectus carinatum, sometimes called “pigeon chest” and can be treated surgically or non-surgically. Surgical correction involves an operation under general anesthesia. It requires an incision across the chest to remove abnormal ribs and reshape the sternum.
Salem was a candidate for non-surgical bracing, which is an excellent alternative to surgery for many patients. He was the first patient at Kalispell Regional Healthcare to be fitted with a T-Joe Bracing System, which is customized specifically for each patient, ensuring a comfortable fit and the best possible correction. The brace consists of a metal belt and cushioned compression zone that applies constant pressure on the protruding chest wall to remold it. Using this brace requires commitment as patients have to wear it for 23 hours a day, for up to a year. When treatment is complete, the protrusion in his chest will be permanently reshaped.
“Correcting children’s chest wall deformities is a very rewarding area of pediatric surgery. It can really transform the child’s outlook on life - whether it’s because they can now participate in sports with their friends again or because of their improved self-image,” said Dr. Falk.
For more information about the Pediatric Surgery Chest Wall Deformity Clinic at Kalispell Regional Healthcare, go online to krh.org/children or call (406) 758-7089.