Understanding Pectus Excavatum in Adolescents
Pectus excavatum, also known as sunken chest or funnel chest, is a relatively common congenital deformity that affects adolescents. It occurs when an abnormal growth of cartilage within the chest wall pushes the sternum, or breastbone, and ribs inward, creating a caved - in or sunken appearance (source: Lurie Children's Chest Wall Deformities Program). This condition can range from mild to severe, and in some cases, it may cause various physical and psychological issues.
Physical and Psychological Impacts
Physically, severe pectus excavatum can affect lung capacity, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. It may also lead to problems with bone growth and alignment later in life. For adolescents, these physical limitations can significantly impact their ability to participate in sports and other high - stress physical activities, as noted in the information from Columbia Surgery.
Psychologically, pectus excavatum can have negative effects on self - esteem, especially during the adolescent years when appearance is a significant concern. Teens may feel self - conscious and avoid activities that expose the chest, such as swimming or going to the beach. This can lead to social withdrawal and difficult peer interactions.
Diagnosis of Pectus Excavatum
Diagnosing pectus excavatum typically involves multiple steps. Initially, a visual examination of the chest can reveal the characteristic sunken appearance. Additionally, auscultation, which is the analysis of sounds of the heart and chest, can detect the condition's effect on heart and lung function. Other diagnostic tools include electrocardiogram (ECG), echocardiogram, pulmonary function testing, chest x - ray, and CT - scan. The Haller index, calculated using the CT scan, is a measure of the extent of pectus excavatum. A Haller index greater than 3.25 is generally considered severe (source: Columbia Surgery).
Top Institutions for Adolescent Pectus Excavatum Correction in New York City
1. Stony Brook Medicine's Chest Wall Clinic
Overview
Stony Brook Medicine's Chest Wall Clinic focuses on treating pectus excavatum (PE) in adolescents and young adults. PE causes the sternum and a number of ribs to grow abnormally, creating a concave look. In mild cases, the appearance may cause self - consciousness, while in severe cases, it can cause problems with the lungs or heart, according to Dr. Richard Scriven, a pediatric surgeon at Stony Brook (source: Stony Brook Medicine's Chest Wall Clinic Focuses on a Common Adolescent Congenital Deformity).
Treatment Approach
The clinic uses the Nuss procedure with cryoablation to treat PE patients. The Nuss procedure is a minimally invasive surgery. Under general anesthesia, it is done with a laparoscope and only requires small incisions on each side of the chest. The surgeons also use cryoablation, which freezes the nerves in the chest and helps to reduce post - op pain and make recovery easier. A U - shaped titanium bar is placed through one of the incisions, rotated, and attached to the patient's chest wall with stitches. The bar is usually kept in for two to three years and is removed with a minor surgical procedure. Prior to the development of the Nuss procedure, the Ravitch procedure, a much more invasive operation, was used for PE correction. The Ravitch procedure involved cutting open the patient's chest and reconstructing it, which required a long hospital stay, long recovery period, and more post - op pain.
Success Rate and Patient Experience
Dr. Ankit Dhamija mentioned that the Nuss procedure has an overall satisfaction rating of 95.6 percent of patients being either satisfied or very satisfied after the operation. The addition of cryoablation to this procedure has made the initial recovery much more tolerable, and patients are often discharged one - to - two days after the operation. Nuss procedure patients usually stay overnight in the hospital, and opioid use is reduced because of the minimally invasive aspect and cryoablation. The patients may be sore for the first few weeks, and full recovery from the surgery may take up to six months, but most are back to regular activities much sooner. However, heavy lifting and contact sports should be avoided during the healing period.
2. Columbia Surgery
Comprehensive Treatment
Columbia Surgery offers comprehensive care for pectus excavatum in adolescents. They recognize that the condition can have a significant impact on a patient's physical and psychological well - being. The ideal age for surgical treatment of pectus excavatum at Columbia Surgery is between 12 and 18 years. The goal of surgery is to improve breathing, posture, and cardiac function, in addition to giving the chest a normal appearance. This is typically accomplished by repositioning the breastbone.
Surgical Options
Columbia Surgery provides two main surgical options: the minimally invasive Nuss procedure and the modified Ravitch repair. The Nuss procedure is performed with general anesthesia using video - assisted thoracoscopic surgery (VATS). It creates a horizontal passage underneath the sternum through two small incisions in the side of the chest. A convex bar, known as the Lorenz pectus bar, is specially shaped to fit the individual's anatomy, inserted through the passage, and then turned to push the sternum outward. The bar must remain in place for a minimum of three years while the chest contour re - forms to its new shape, and it is removed as an outpatient procedure. The modified Ravitch repair, performed under general anesthesia, involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. Titanium bars are secured to the ribs and sternum to support the repaired chest architecture. Unlike previous techniques, the current bars can remain permanently in place, avoiding the need for a second operation.
Recovery and Success
Recovery after pectus excavatum repair at Columbia Surgery varies depending on the person's age and the amount of chest depression. After surgery, most people leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. One must avoid vigorous exercise for the first month after surgery and contact sports for three months after surgery. Surgical repair at Columbia Surgery has excellent success rates, and in the majority of cases, cardiovascular and lung function returns to near normal.
3. [Placeholder: Another potential top institution. Based on available sources, more data is needed to present a third institution of similar caliber in New York City. If we consider related regional institutions, the Center of Excellence for Pectus could be considered, though it is in New Jersey. It will be presented here for additional information.] Center of Excellence for Pectus
Expertise in Nuss Procedure
The Center of Excellence for Pectus, established in 2005, is a premier center for the Nuss procedure to treat pectus excavatum and evaluate all forms of pectus. Dr. Barry Losasso, a board - certified adult and pediatric general surgeon, has directed the center. He trained with Dr. Donald Nuss, the founder of the Nuss procedure, and has performed over 1,400 minimally invasive Nuss procedures to correct pectus excavatum in both adolescents and adults (ages 10 - 55 years old).
Patient - Centered Approach
The center takes a patient - centered approach. They believe that the best age to get the Nuss procedure is between 13 – 16 years old when the chest’s cartilage and bones are still malleable and easier to manipulate. However, Dr. Losasso has successfully completed many Nuss procedures in patients as old as 53 years old. The center also has an excellent pain management team at the award - winning Valley Hospital, where Dr. Losasso performs the Nuss procedure. Multiple pain management modalities, both within the operating room and post - operatively, are utilized to ensure patients have a successful and uneventful recovery. Most patients feel very little pain following the surgery and are quite comfortable throughout their stay at the hospital.
Comparative Analysis of the Institutions
| Institution | Treatment Approach | Recovery Time | Success Rate | Special Features |
|---|---|---|---|---|
| Stony Brook Medicine's Chest Wall Clinic | Nuss procedure with cryoablation | Overnight hospital stay, full recovery up to six months | 95.6% satisfaction rate | Reduced post - op pain with cryoablation, minimally invasive |
| Columbia Surgery | Nuss procedure and modified Ravitch repair | 3 - 5 days hospital stay, return to normal in 2 - 3 weeks | Excellent success rates, improved heart and lung function | Multiple surgical options, permanent bar in modified Ravitch repair |
| Center of Excellence for Pectus | Nuss procedure | Not clearly defined but emphasizes pain management | Over 1,400 successful procedures | Experienced surgeon trained by the founder of Nuss procedure, patient - centered pain management |
Other Considerations for Adolescent Pectus Excavatum Treatment
Pre - operative Considerations
Before undergoing pectus excavatum correction surgery, a complete medical exam and various medical tests are necessary. These may include an electrocardiogram (ECG) and possibly an echocardiogram to show how the heart is functioning, pulmonary function tests to check for breathing problems, and a CT scan or MRI of the chest. It is also important to inform the surgeon about any medications the adolescent is taking, including over - the - counter drugs, herbs, vitamins, or other supplements, as well as any allergies to medicine, latex, tape, or skin cleanser. In the days before surgery, some blood - thinning drugs may need to be stopped, as per the surgeon's instructions. On the day of surgery, the patient will likely be asked not to drink or eat anything after midnight the night before, but should take any drugs as directed by the surgeon with a small sip of water.
Post - operative Care
After surgery, the length of hospital stay varies. At Stony Brook Medicine, patients having the Nuss procedure usually stay overnight, while at Columbia Surgery, most people leave the hospital within 3 to 5 days. Pain management is a crucial aspect of post - operative care. Strong pain medicine may be given in the vein or through a catheter placed in the spine in the first few days, followed by oral medications. Patients may have tubes in the chest around the surgical cuts to drain extra fluid, which are removed once the drainage stops. Physical activity is restricted initially, with limitations on bending, twisting, or rolling from side to side. Gradually, activities can be increased, and after a certain period, the patient can return to normal activities, although contact sports are usually avoided for several months.
Psychological Support
Adolescents undergoing pectus excavatum correction may also need psychological support. The condition can have a significant impact on their self - esteem, and the surgical process can be stressful. Some institutions may offer support groups or counseling services to help patients and their families cope with the emotional aspects of the treatment. Encouraging open communication and providing a positive environment can also contribute to the overall well - being of the adolescent during and after the treatment.
Conclusion
In conclusion, adolescent pectus excavatum is a condition that can have both physical and psychological impacts on the affected individuals. The top institutions in New York City, such as Stony Brook Medicine's Chest Wall Clinic and Columbia Surgery, offer advanced treatment options, including minimally invasive surgical procedures with high success rates. These institutions focus on reducing pain, shortening recovery time, and improving the overall quality of life for their patients. Another notable institution, the Center of Excellence for Pectus, also provides expertise in the Nuss procedure with a patient - centered approach. When considering treatment, it is essential to take into account pre - operative and post - operative care, as well as the psychological well - being of the adolescent.
If you or your adolescent child is dealing with pectus excavatum, we encourage you to reach out to these institutions for more information. Contact Stony Brook Medicine at 631 - 444 - 2293 (for patients < 18) or 631 - 444 - 2981 (for patients > 18), Columbia Surgery at (212) 305 - 3408 for existing patients or (212) 304 - 7535 for new patients, or the Center of Excellence for Pectus at 201 - 225 - 9440. Take the first step towards a better quality of life by exploring the treatment options available.
