Pectus Carinatum, in earlier times detrimentally referred to as "pidgeon chest" is a deformity of the chest characterized by a protrusion of the sternum and the ribs.

CAUSES
Possible causes are, among other things, Marfan syndrome, Morquio syndrome and Scoliosis. Scoliosis is chartacterized as a curvature of the spine.

INCIDENCE
Pectus deformities are common, (about 1 in 400 births). Pectus Carinatum is more rare the Pectus Excavatum, another pectus disorder occurring in 20% of Pectus deformities. Pectus Carinatum occurs most commonly in males with an incidence rate of about 75% of patients. With the chest wall held in an outward position, Pectus Carinatum may prevent complete expiration of air from the lungs considerably restricting air exchange. These patients can often experience shortness of breath, wheezing and sometimes mild to moderate asthma. Thus, with exercise, Pectus Carinatum patients often develop a very rapid respiratory rate.

Some patients with Pectus Carinatum also have Scoliosis (spine curvature). Some also may have Mitral Valve Prolapse, a condition where the heart Mitral Valve functions abnormally. Connective tissue disorders involving structural abnormalities of the major blood vessels and heart valves are also known to be associated with Pectus Carinatum. Rarely, some other connective tissue disorders including arthritis, abnormal growth, visual impairment and healing impairment have been also been known to be associated with Pectus Carinatum.

Pectus Carinatum deformity usually is most severe in adolescence during growth and remains unchanged at the end of growth. Adults often experience increasing symptoms over time. Although the ribs and cartilage of the chest wall are not improved by body building exercises, they are not harmful and may improve cosmesis of the deformity.

TREATMENT

BRACING
In patients who have not finished growth and have mild to moderate Pectus Carinatum and are motivated to avoid surgery, the use of a Custom Fabricated Orthosis that pushes directly on the deformity usually produces excellent results. Compliance to the wearing regimen is essential for the success of this treatment. The Custom Fabricated Orthosis works much the same way Orthodonture(braces) work to correct alignment of teeth. The Custom Fabricated Orthosis is designed with front and back compression pads attached to aluminum bars. The front and back are joined by a Dynamic Corrective Force Connection which, when properly applied, automatically provides optimal corrective force at all times. The Custom Fabricated Orthosis is easily hidden under clothing and must be worn over a torso innerface for 14-16 hours per day until growth is finished. All patients under Orthotic management are seen on a regular basis to ensure fit during growth and that corrective forces are maintained. At the start and end of treatment, all patients are digitally scanned to measure corrective improvement. Pediatric surgeons usually see the patients every six months to monitor progress.

SURGERY
In patients who are not candidates for Orthotic Pectus Carinatum treatment, surgery may be needed to restore normal chest contour. Open surgery in males is performed through a horizontal incision on the anterior chest wall just below the nipple area. In females, the incision is placed to coincide with the breast margins when possible. The abnormal lower four to five cartilages are removed leaving the perichondrium which is the lining the envelops the outer part of the rib. This allows the cartilage to re-grow into its new position. The sternum is surgically fractured and placed in the corrected position. The incision is usually closed with internal sutures minimizing scarring.

Hospitalization is usually three to four days and patients often have discomfort for several weeks. Cosmetic and physical outcomes for surgical patients in mid childhood or early adolescence are generally excellent.