Expert Care in Denver for Chest Wall Deformities
As the leading experts in the treatment and correction of chest wall deformities in the region, The Chest Wall Deformity Correction Center and Bracing Clinic at Rocky Mountain Hospital for Children provides convenient access to options, expertise and compassionate care for your child. We know you want the best, and our teams are ready help.
Whether families are looking for state-of-the-art cryoablation to greatly alleviate pain associated with the minimally invasive Nuss Procedure or a non-invasive custom dynamic compression device for Pectus Carinatum, Rocky Mountain Hospital for Children is home to some of the most experienced Chest Wall Specialists in the entire Rocky Mountain region.
Not only is RMHC the only facility in the Rocky Mountain Region to offer a dynamic compression brace for the non-invasive treatment for Pectus Carinatum, we are one of only a few in the entire country. Additionally, Dr. Marcelo Martinez-Ferro, a world-renowned physician and the developer of the dynamic compression brace, has personally worked in Denver with RMHC’s pediatric surgeons and their patients.
For more information about The Chest Wall Deformity Correction Center and Bracing Clinic, call (303) 839-6001.
Understanding Chest Wall Deformities
Chest wall deformities occur when the cartilage that connects the ribs grows at an uneven pace.
Pectus Excavatum, also known as funnel chest or sunken chest, represents 90% of all chest wall deformities. It occurs in up to 1 in 400 live births and tends to affect males more than females at a rate of 5 to 1.
Pectus Excavatum is diagnosed after a physical exam by a pediatric surgeon and most noticeable when children go through a rapid growth spurt in their teen years. It may cause back pain, shortness of breath, exercise intolerance and chest pain.
The pediatric surgeons at Rocky Mountain Hospital for Children correct Pectus Excavatum using a minimally invasive surgical procedure called the Nuss Procedure whereby surgeons use small incisions that are approximately 1 inch long on each side of the chest. The surgeons use the incisions to place a customized curved steel bar under the sternum to instantly correct the pectus excavatum.
This procedure is now offered with cryoablation (in most cases) which minimizes any pain associated with the procedure without the extended need for narcotics. With cryoablation, our specially trained pediatric surgeons use a unique freezing method to block targeted nerves near the incision site so that they don’t transmit pain for several months. With this new tool, patients are often discharged home on the first post-operative day and with little to no pain.
Pectus Carinatum, is the second most common chest wall deformity. It is identified by an overgrowth of rib cartilage that causes the chest to protrude forward. The condition is about four times more likely to occur in boys than girls.
There are three ways in which Pectus Carinatum occurs. The most common occurrence is during a growth spurt in pre-adolescent males between 11 and 14 years old. The second most common is from birth – a pigeon-chested appearance is evident in newborns, and between two and three-year-old children, the chest continues to growth further outward. The least common occurrence is after open heart surgery. In these cases, the sternum fails to heal flat and results in pectus carinatum.
Pectus carinatum symptoms
Most children with Pectus Carinatum develop normal hearts and lungs, but the deformity of the chest wall could prevent them from functioning at their optimal capability. Many children with Pectus Carinatum will experience shortness of breath during activity, decreased endurance and some chest pain.
In addition to the physical symptoms, there can also be psychosocial implications. The shape of the chest can cause embarrassment, lack of self-confidence and possible disruption to social connection through adolescence and into adulthood.
Pigeon chest treatments
There are two ways our Denver pediatric specialists treat Pectus Carinatum at RMHC. The first more common option is a non-invasive, external custom bracing technique, and the second option is with pediatric surgery.
External sternum bracing with a custom dynamic compression device produces superior results without a surgical procedure. The chest is still compliant during childhood and adolescence, so the dynamic compression device is an obvious choice of treatment because it causes the least amount of discomfort as it corrects the chest wall abnormality.
Custom bracing of the chest applies pressure and through measured adjustment by a pediatric surgeon encourages gradual movement of the sternum in the same way that orthodontic braces move teeth into position. The dynamic compression device is the newest brace available for the external treatment of chest wall deformities.
It consists of a front-cushioned compression plate that is held in place by multiple light-weight, curved aluminum segments fastened together by screws to form a rigid belt. The plate then applies pressure at the highest part of the protrusion. The dynamic compression device is custom created for each child and designed to fit tight to the chest and middle of the back. It is fairly small and not too noticeable under clothing.
The key to successful treatment with the dynamic compression device is wearing the brace consistently. Patients are encouraged to wear the brace as much as possible, up to 23 hours per day. The brace can be removed for showering, bathing and when participating in sports, but it should be worn at all other times.
Once the physician has determined the correction has been made, the patient will transition into a “retainer” phase. During this phase of treatment, daily wear of the brace will be reduced. On average, the treatment and retainer phases can last anywhere from six to 24 months or more, depending on severity of pectus carinatum and the child’s responses to the brace correction.
FAQs about the bracing technique
There will be times, such as after adjustments, where children may experience some discomfort, but it should not be painful. Most children will say their chest is sore after the initial fitting and subsequent adjustments. This can be treated with over-the-counter medications, such as ibuprofen (Motrin/Advil) or acetaminophen (Tylenol).
If your child has trouble sleeping with the brace, apply a memory foam or similar type of padding over the mattress for increased comfort.
There is a very small chance that pectus carinatum could reoccur after treatment with the dynamic compression device. Recurrence has most commonly been noted during a rapid growth spurt and typically several months after the correction. In those instances, we would begin treatment with the brace again until the correction was made.
If the brace has been worn as directed by the physician and has been worn for at least two years without improvement, surgical intervention may be considered. At that time, the patient and his or her parents/guardian and the surgeon would discuss options and form a new plan of care.
Chest wall correction surgery
Surgical correction for pectus carinatum is a well-established and recognized option for treatment when bracing is not appropriate.
Surgery to correct pectus carinatum involves reshaping and/or removing abnormal rib cartilage. The sternum (breast bone) could also need revision or reposition. An incision will be made in the center of the chest to repair the abnormality. Post-operative drains will be in place for three to six days after surgery and will be removed when drainage decreases.
After a pectus carinatum correction surgery, your child may be hospitalized for three to five days. He or she will be under strict activity restrictions for a minimum of two to three months after surgery.
Schedule an appointment
As the leading experts in the treatment and correction of chest wall deformities in Denver, patients travel from all over the Rocky Mountain region and beyond to receive care from The Chest Wall Deformity Correction and Bracing Clinic at RMHC.
To schedule an appointment with The Chest Wall Deformity Correction and Bracing Clinic at RMHC, please call (303) 839-6001.
Our chest wall clinic location
The Chest Wall Deformity Correction Center and Bracing Clinic at RMHC is located just minutes from Denver International Airport, one of the largest airports in the U.S. with nonstop flights to over 150 domestic destinations, making it the most accessible chest wall repair clinic offering the dynamic compression device in the country.