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Unveiling the Nuss Procedure
Life Health - Pectus excavatum, commonly known as "sunken chest," is a congenital deformity of the chest wall that causes the breastbone and ribs to grow abnormally. This condition can lead to physical and psychological discomfort, impacting self-esteem and overall quality of life. The Nuss procedure, a revolutionary surgical technique, has emerged as a minimally invasive solution to correct pectus excavatum and transform lives.
What is Pectus Excavatum?
Pectus excavatum occurs due to the abnormal growth of the cartilage that connects the ribs to the breastbone. This results in a depression in the chest, which can vary in severity from mild to severe. The condition is often identified during childhood or adolescence and may lead to symptoms like difficulty in breathing, chest pain, and decreased lung capacity.
Patients with Pectus Excavatum usually have a sternum that looks concave resembling a closed funnel. This is why Pectus Excavatum is also known as 'sunken chest'.
These bone disorders include congenital or genetically influenced congenital abnormalities, so they can often be detected at birth. Pectus Excavatum will be more visible when someone is 2 years old.
However, the occurrence of Pectus Excavatum can also be seen in the early teens. It has been reported that Pectus Excavatum is more common in males than females. Pectus excavatum is rare, but this disorder can be dangerous.
The severity of Pectus Excavatum can be mild, moderate, and severe. Pectus Excavatum with mild conditions only reduces the beauty of the appearance, but severe Pectus Excavatum can put pressure on the heart and lungs.
This can cause several complications related to the functions that include the two organs. However, there is no need to worry because Pectus Excavatum can be overcome, especially if it is done long before entering adolescence.
Causes of Pectus Excavatum
The cause of Pectus Excavatum is still not known with certainty. However, it is strongly suspected that Pectus Excavatum occurs due to genetic abnormalities in the chromosomes associated with the development of the ribs and sternum.
The disorder causes defects in the cartilage tissue that supports certain ribs. These ribs are the ribs that lead to the sternum. The defect in the rib causes the cartilage there to push the sternum inward.
The following are some of the risk factors for Pectus Excavatum:
- Gender – boys have a higher chance of experiencing Pectus Excavatum than girls
- Family history – having a family history of Pectus Excavatum increases the risk factors for the offspring
- Suffering from Certain Syndromes – Some syndromes like Marfan Syndrome, Ehlers-Danlos Syndrome, Noonan Syndrome, and Turner Syndrome increase the chance of developing Pectus Excavatum
- Scoliosis – children who have Pectus Excavatum usually also have scoliosis, which is where the spine curves
Symptoms of Pectus Excavatum
One symptom that is definitely seen in sufferers of Pectus Excavatum is the appearance of the chest that is indented, so that it looks like a funnel. The symptoms of this Pectus Excavatum usually get worse from adolescence to adulthood.
It has been mentioned that severe levels of Pectus Excavatum can compress the heart and lungs. If Pectus Excavatum is like that, then there are several symptoms, namely:
- Frequent shortness of breath
- Chest pain
- Palpitations (heart beating fast)
- Wheezing or coughing
- Often feel tired
- Frequent respiratory tract infections
- Have short breath
- Stamina is not good
- Rarely do sports
When to go to the doctor?
If you or a family member has a hollow around the sternum, then get checked out immediately or take him to the doctor. Moreover, if the appearance of a sunken chest is accompanied by some of the symptoms that have been mentioned.
People with sunken chests who experience some of these symptoms may already be in a severe stage, so they need to be treated immediately so they don't get worse.
Diagnosis of Pectus Excavatum
After arriving at the doctor's office, the doctor will take several actions to diagnose the incidence of Pectus Excavatum in patients. The first diagnosis is made by digging up health information and symptoms experienced.
The doctor will examine your chest to see the condition of the hollow in the chest. In addition, there are some tests that need to be done.
Imaging test
Imaging tests that can be used to diagnose Pectus Excavatum are chest X-rays and CT scans. A chest X-ray uses X-rays to see the tilt of the sternum. There may be some discomfort when you are having an X-ray.
A CT scan can help doctors determine the severity of Pectus Excavatum. The CT scan image can visualize the condition and position of the sternum and ribs in relation to the heart and lungs.
Electrocardiogram
If the doctor suspects that Pectus Excavatum is pressing on the heart, then you need to undergo an electrocardiogram. This diagnosis is useful to show your heart rhythm, whether normal or irregular.
Echocardiogram
An echocardiogram is done with the aim of seeing the working condition of the heart and the condition of its valves. The results can support doctors to conclude heart health conditions in patients with Pectus Excavatum.
Lung function test
Ribs and sternum pressing on the lungs can be tested for certainty using lung function tests. Pulmonary function tests will measure the amount of air the lungs can hold and how quickly they empty the air.
Physical exercise test
One of the symptoms of a severe level of Pectus Excavatum which is pressing on the lungs and heart is decreased stamina, shortness of breath, and reluctance to exercise. An exercise test can help your doctor determine your heart and lung function while exercising.
Pectus excavatum complications
Pectus Excavatum can cause several complications, especially in severe cases. Some of these complications can be mild to serious.
The following are complications of Pectus Excavatum that may occur:
- Lack of confidence
- Excommunicated
- Heart problems
- Lung problems
- Low productivity
Treatment of Pectus Excavatum
Treatment for Pectus Excavatum depends on the severity and symptoms experienced. Patients with mild levels of Pectus Excavatum only need treatment by undergoing some physical therapy.
The physical therapy aims to improve posture and increase the angle at the sternum. However, if Pectus Excavatum is severe, then the treatment is surgery.
There are two types of surgery that are most commonly performed to treat cases of Pectus Excavatum, namely smaller incisions and larger incisions. The operation was carried out so that the sternum could be raised in position, so it would not put pressure on the heart and lungs.
Traditional Approaches to Correction
In the past, the Ravitch procedure was the standard surgical method for correcting pectus excavatum. This open surgical technique involved making large incisions and repositioning the sternum and ribs. While effective, it carried higher risks, prolonged recovery times, and visible scarring.
The Nuss Procedure: A Game-Changer
The Nuss procedure, introduced by Dr. Donald Nuss in 1997, revolutionized the approach to treating pectus excavatum. This minimally invasive technique involves making small incisions on the chest and inserting a curved metal bar under the sternum to elevate it. The bar is then secured, gradually reshaping the chest over time. The Nuss procedure offers several advantages over traditional methods:
Minimally Invasive Nature
Unlike the open Ravitch procedure, the Nuss procedure requires only a few small incisions. This leads to less trauma to the surrounding tissues, reduced pain, and faster recovery times.
Shorter Hospital Stay
Patients undergoing the Nuss procedure typically spend a shorter time in the hospital compared to traditional surgery. This helps to minimize healthcare costs and allows individuals to resume their daily activities sooner.
Improved Cosmetic Outcome
The Nuss procedure results in significantly less visible scarring compared to open surgery. This is especially important for younger patients who may feel self-conscious about their appearance.
Enhanced Patient Experience
The minimally invasive nature of the Nuss procedure translates to reduced pain and discomfort. Patients often experience less postoperative pain and require milder pain medication.
The Nuss Procedure: Step by Step
- Preoperative Assessment: Patients undergo a comprehensive evaluation, including medical history, physical examination, and imaging studies, to determine their suitability for the Nuss procedure.
- Surgical Incisions: Small incisions, usually on the sides of the chest, are made to create access points for the insertion of the metal bar.
- Bar Insertion: The curved metal bar is carefully guided under the sternum, gently lifting it into a more normal position.
- Bar Securing: The bar is secured to the ribs, holding them in place. Over time, the chest wall gradually reshapes to a more natural contour.
- Monitoring and Removal: The patient's progress is monitored through regular check-ups and imaging. After approximately two to three years, the bar is removed in a minor surgical procedure.
FAQs
Q: Is the Nuss procedure suitable for all cases of pectus excavatum?
- A: The Nuss procedure is effective for a wide range of cases, from moderate to severe. However, a thorough assessment by a qualified surgeon is necessary to determine the most suitable treatment approach.
Q: What is the recovery time after the Nuss procedure?
- A: Recovery times vary, but patients typically return to school or work within a few weeks. Strenuous physical activity should be avoided for several months.
Q: Are there risks associated with the Nuss procedure?
- A: As with any surgery, there are risks, such as infection and bar displacement. However, these risks are minimized with proper surgical technique and postoperative care.
Q: Can adults undergo the Nuss procedure?
- A: While the Nuss procedure is commonly performed on children and adolescents, adults with pectus excavatum can also benefit from the surgery. The eligibility is assessed on an individual basis.
Q: How long does the reshaping process take?
- A: The chest reshaping process occurs gradually over a period of approximately two to three years, during which the metal bar is in place.
Bottom Line
The Nuss procedure has transformed the treatment of pectus excavatum, offering a minimally invasive alternative to traditional open surgery. With its shorter recovery times, improved cosmetic outcomes, and enhanced patient experience, the Nuss procedure has given hope to countless individuals dealing with the physical and emotional challenges of this condition. If you or a loved one is struggling with pectus excavatum, it's worth exploring the potential benefits of the Nuss procedure.
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