Chest-deformities: a proposal for a classification
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Chest-deformities: a proposal for a classification G.H. Willital, A.K. Saxena, U. Schütze, W. Richter Münster, Germany Background: In this article we assess the significance of classifying chest-deformities based on morphological findings in type-related treatment and its results.
Review article
Data sources: Recent publications on chest-deformities in children and youth were retrieved from PubMed and Medline and from our clinical and intraoperative findings. Results: Chest-deformities are diagnosed by thoraxmeasurements using a flexible meter projected on a graph-paper by MR/CT investigations and color coded videorasterstereography. In addition an ultrasound guided mediastinal analysis is performed on the heart, the great vessels and mediastinal organs. These investigations could determine meticulously the morphology of the sternum, the sterno-costal segments and the costal arch, enabling to find different chest wall deformities, i.e., 11 different types. The clinical and surgical significance of such a classification can be shown by comparing postoperative results of non-classified chest-deformities with those of classified. Preoperatively non-classified chest-deformities often have postoperative asymmetric shapes, partial local recurrences, costal arch eversions and a platythorax. Such a classification can be used to analyze and predict socalled "secondary associated alterations" of the vertebral column or mediastinal organs. Conclusions: Determining the specific type of a thorax deformity could be considered a type-related physiotherapy as conservative treatment or vacuum treatment and if surgery is indicated a type-related surgical correction can be performed. A type-related and adapted surgical correction can prevent subsequent mitral valve prolapse, recurrent infections, vertebral disturbances caused by kypho-scoliosis and increasing psychological irritation. Typing chest-deformities are an
Author Affiliations: Pediatric Surgical Clinic, University Clinic Graz, Austria (Saxena A); Pediatric Surgical Research Institute Münster, Germany (Schütze U); Surgical Clinic Hospital Mühldorf/Inn, Munich, Germany (Richter W)
additional and essential help for the surgeon to perform specific surgical procedures: detorsion of the sternum, correction of the sterno-costal region, the costal arch bow and the kind of chest wall immobilization by metal struts. It can also compare the postoperative results more accurately in similar types of chest-deformities. World J Pediatr 2011;7(2):118-123 Key words: chest-deformities; classification; funnel chest
Introduction
C
hest-deformities have an incidence of approximately 1:1000.[1] Genetic studies have proved a congenital origin.[2] Chest-deformities must not always be present at birth. They can develop gradually in the first 5 years of life. [3] Histological and electron microscopic investigations have shown an increased growth of cartilage at the sternocostal junction.[4] Chondrocyts in this region have a hypoplastic structure causing a diminished stability of the sterno-co
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