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Which is better - surgery or non-operative treatment?

In either case by beginning with non-operative treatment we certainly reduce the risk of complications, and certainly diminish postoperative pain by making the chest wall more pliable. Additionally by improving posture, which is a must in all the patients, postoperative pain and discomfort can be reduced. Most patients after surgery tend to protect themselves from even normal mobility in fear of the metal plate being dislocated. So nonoperative treatment is a must before surgical repair.

When should the patient be seen by the doctor for the first time?

The earlier the better. At as  early as a few months of life a depressed chest may be due to obstructed breathing in developing asthma rather than isolated pectus excavatum. Early advising on supportive physiotherapy may improve the position of the chest as well as make breathing easier.

What tests are required?

A  simple measurement of the depression with a ruler adds little to our knowledge of the problem. In order to assess the severity of the defect a computerised axial tomography (CAT scan) or NMR is required. The depressed ribs and sternum may exert pressure on the heart and result in valve back flow of the blood. Secondly, a constriction to the coronary vessels is also possible. Lastly, the heart becomes displaced to the left thus compromising the left lung compartment.  ECHO is equally suitable to detect heart valve dysfunction. All these tests are of lesser importance in younger children, possibly less than 10 years, as the chest at his age is considerably elastic to make up for even major chest deformity. We find spirometry of lesser importance.

Additional information from the parents regarding possible compound inborn syndromes may require additional tests and examinations.

When should treatment start?

It is our policy to begin the treatment as soon as we see the patient. Generally it is focused on improving bad posture by strengthening the dorsal muscles, and abdominals with proper breathing exercises. 

Is the suction cup necessary?

The suction cup can grossly mobilise the depressed sternum and ribs. It further requires fixation in an elevated position either with intensive physiotherapy or metal plate inserted during surgery. The suction cup is not a goal in itself but constitutes an important part of either method of treatment.
How long is the nonoperative treatment ?

By analogy to dental realignment of teeth, nonoperative approach needs time. It usually requires 1-3 years although early effects can be expected already in a few weeks.

Does non-operative treatment exclude surgery?

On the contrary, it can additionally support surgical treatment and should proceed any surgery.  


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