WHAT IS BEACON PECTUS CLINIC?
Beacon Pectus Clinic is a specialised service that provides the most innovative care for children with chest wall deformities. This service is led by Mr Brice Antao, Consultant Paediatric Surgeon who has more than 10 years experience in the management of chest wall deformities in the UK, USA and Ireland. In collaboration with other international experts in this field, he was the first to introduce non-surgical strategies such as pectus bracing and the vacuum bell for the management of chest wall deformities for children in Ireland.
WHAT IS A PECTUS?
Pectus is a chest wall deformity where the chest appears irregularly shaped. It is present at birth but often becomes more noticeable in early adolescence, when the ribcage and the rest of the body undergo growth spurts during puberty. Often both sides of the ribs are affected but in some cases it can appear asymmetrical with one side worse than the other.
The two common deformities of the anterior chest wall are:
Pectus Excavatum, also known as ‘funnel’ or ‘sunken’ chest. This is where the breast bone is pushed abnormally inwards and the chest appears caved-in or sunken. This condition affects around one in 300 people, with a 3:1 male to female ratio.
Pectus Carinatum, also known as ‘pigeon’ chest is where the breast bone is pushed outwards. This condition affects around one in 1000 people, with a 4:1 male to female ratio.
In addition, there are other rare mixed pectus deformities (combination of pectus excavatum and pectus carinatum).
The exact cause of pectus deformities is unknown, though it’s largely attributed to abnormal cartilage overgrowth between the bony ribs and the sternum (breast bone), causing it to buckle outwards (pectus carinatum) or inwards (pectus excavatum). Although no genetic link has been identified, these deformities are known to run in families with 1 in 4 cases reporting similar deformities in other family members. Pectus deformities are commonly seen in isolation or can be associated with certain syndromes such as Poland syndrome (a rare genetic disorder characterised by missing or poorly developed muscles on one side of the body leading to abnormalities of the chest, shoulder, arm and hand) or Marfan’s syndrome (connective tissue disorder that can cause a cluster of problems including problems with the eyes, heart, lungs and central nervous system).
Pectus deformities are often associated with other skeletal problems in 1 in 3 patients, often referred to as a ‘pectus syndrome’ and include:
Spine: Spinal problems are often seen in children with pectus deformities. They include excessive outward curvature of the spine (Scheurmann’s syndrome or juvenile kyphosis), kyphosis of the head and neck, lordosis of the lower spine and scoliosis.
Head and Neck: In many pectus children, the head appears to be pushed forward and the neck excessively flexed. This is partly due to the altered centre of gravity caused by the pectus defect, in addition to very tight pectoralis muscles and weak upper back muscles.
Shoulders: The shoulders may also be uneven, where one may dip or drop compared to the other. In some cases there is a lateral rotation of the shoulder causing protrusion of the shoulder blades (scapular winging).
Abdomen and Pelvis: The abdomen or belly can sometimes appear to be protruding (pot belly). This can be associated with poor muscle and pelvic tone and may be exaggerated by the lower ribcage appearing to stick out (rib flaring) and anterior pelvic tilt.
Costal margins: Associated abnormalities of costal margins (ribcage) are often seen in children with pectus deformities. This typically affects the lower ribs and the lower edge of the ribcage causing lower ribs and the costal margin either on one or both sides to stick out (rib flaring) or to be pulled in (rib flattening).
The presence of symptoms in patients with a pectus deformity is variable and depends on the severity of the defect. Although most patients are generally asymptomatic, some of them can develop atypical chest and back pain. Other common symptoms include breathlessness worse on exertion. The most common symptom seen in patients with pectus deformity is a feeling of unhappiness with the appearance of the pectus deformity. This can have a significant psychological impact on the patient’s self-esteem, body image and confidence.
TREATMENT OF PECTUS DEFORMITIES
Traditionally, these deformities have been corrected using different surgical techniques. More recently non-operative treatment options such as vacuum bell and pectus bracing have been developed for the management of these deformities. Here at Beacon Pectus Clinic, we provide an expert opinion on all types of pectus deformities and are able to offer these novel non-surgical strategies for the management of chest wall deformities in children and adolescents.
PECTUS BRACING FOR PECTUS CARINATUM
Non-surgical treatments using compressive orthoses have been used in the management of pectus carinatum worldwide. The American Paediatric Surgical Association recommend pectus bracing as first line treatment for pectus carinatum. Compressive orthoses (pectus braces) are designed to place the external forces on the point of the most prominent sternal protrusion of the deformity to provide continued pressure to stimulate bone and cartilage remodelling. This treatment, which is provided in an outpatient clinical setting, does not involve surgery and leaves no scars.
Beacon Hospital is the first and the only centre on the Island of Ireland to establish a dedicated pectus service to provide non-surgical and non-invasive therapy for pectus carinatum.
Our bespoke service includes a custom-made brace along with chest wall manipulation, tailored exercise and posture management program, regular brace adjustments and close monitoring of results and follow-up. Our bracing program focuses on the correction of the pectus deformity and also addresses other associated skeletal problems with specific exercise regimes. Patient compliance, close monitoring and diligent follow-up are key to the success of pectus bracing treatment. We use a multidisciplinary approach involving a group of specialist that have experience and expertise in dealing with the entire spectrum of chest wall deformities.
VACUUM BELL THERAPY FOR PECTUS EXCAVATUM
The vacuum bell offers a non-surgical treatment of pectus excavatum. The vacuum bell is a suction cup device that is used to create a vacuum at the chest wall, in order to pull the sternum out. This device is worn several hours each day, and the treatment and outcomes are monitored over a period of 12-18 months. In collaboration with Eckart Klobe, the inventor and manufacturer of the Klobe Vacuum bell, we are able to provide this innovative non-surgical therapy for the management of pectus excavatum. Along with the vacuum bell therapy, our service includes a customised exercise regimen based on a thorough assessment and physical evaluation by a physiotherapist trained and experienced in treating patients with pectus deformities. Our exercise programs are designed to reverse some of the effects of pectus such as weak muscles, loss of flexibility, rib flaring and poor posture.
Patients with pectus deformities, often suffer from low quality of life and impaired body image. Here at the Beacon Pectus Clinic, we are able to offer psychological support and counselling for such patients to cope with their deformity and improve their self-esteem.