461:(braces that correct the alignment of teeth). The brace consists of front and back compression plates that are anchored to aluminum bars. These bars are bound together by a tightening mechanism which varies from brace to brace. This device is easily hidden under clothing and must be worn from 14 to 24 hours a day. The wearing time varies with each brace manufacturer and the managing physicians protocol, which could be based on the severity of the carinatum malformation (mild moderate severe) and if it is symmetric or asymmetric.
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341:. Some parents report that their child's pectus carinatum seemingly popped up overnight. Second most common is the presence of pectus carinatum at or shortly after birth. The condition may be evident in newborns as a rounded anterior chest wall. As the child reaches age 2 or 3 years of age, the outward sternal protrusion becomes more pronounced. Pectus carinatum can also be caused by
247:, a condition in which the heart mitral valve functions abnormally. Connective tissue disorders involving structural abnormalities of the major blood vessels and heart valves are also seen. Although rarely seen, some children have other connective tissue disorders, including arthritis, visual impairment and healing impairment.
232:
to use the accessory muscles for respiration, rather than normal chest muscles, during strenuous exercise. This negatively affects gas exchange and causes a decrease in stamina. Children with pectus malformations often tire sooner than their peers due to shortness of breath and fatigue. Commonly concurrent is mild to moderate
469:
again due to its lower risks and well-documented very high success results. The pectus carinatum guideline of 2012 of the
American Pediatric Surgical Association has stated: "As reconstructive therapy for the compliant pectus malformation, nonoperative compressive orthotic bracing is usually an appropriate
435:(2D and 3D). It may then be found out that the rib cage is in normal structure. If there is more than average growth of sternum than pectus carinatum protrudes. Also it is of two types, as pectus carinatum is symmetrical or unsymmetrical. On the basis of that further treatment is given to the patient.
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as it does not preclude the operative option. For appropriate candidates, orthotic bracing of chest wall malformations can reasonably be expected to prevent worsening of the malformation and often results in a lasting correction of the malformation. Orthotic bracing is often successful in prepubertal
456:
as of 1977, is finding increasing acceptance as an alternative to surgery in select cases of pectus carinatum. In children, teenagers, and young adults who have pectus carinatum and are motivated to avoid surgery, the use of a customized chest-wall brace that applies direct pressure on the protruding
485:
For patients with severe pectus carinatum, surgery may be necessary. However bracing could and may still be the first line of treatment. Some severe cases treated with bracing may result in just enough improvement that patient is happy with the outcome and may not want surgery afterwards. If bracing
231:
People with pectus carinatum usually develop normal hearts and lungs, but the malformation may prevent these from functioning optimally. In moderate to severe cases of pectus carinatum, the chest wall is rigidly held in an outward position. Thus, respirations are inefficient and the individual needs
464:
Depending on the manufacturer and/or the patient's preference, the brace may be worn on the skin or it may be worn over a body 'sock' or sleeve called a
Bracemate, specifically designed to be worn under braces. A physician or orthotist or brace manufacturer's representative can show how to check to
468:
Bracing is becoming more popular over surgery for pectus carinatum, mostly because it eliminates the risks that accompany surgery. The prescribing of bracing as a treatment for pectus carinatum has 'trickled down' from both paediatric and thoracic surgeons to the family physician and pediatricians
525:
Most insurance companies no longer consider chest wall malformations like pectus carinatum to be purely cosmetic conditions. While the psychologic impact of any malformation is real and must be addressed, the physiological concerns must take precedence. The possibility of lifelong cardiopulmonary
509:
After adolescence, some men and women use bodybuilding as a means to hide their malformation. Some women find that their breasts, if large enough, serve the same purpose. Some plastic surgeons perform breast augmentation to disguise mild to moderate cases in women. Bodybuilding is suggested for
250:
Apart from the possible physiologic consequences, pectus malformations can have a significant psychologic impact. Some people, especially those with milder cases, live happily with pectus carinatum. For others, though, the shape of the chest can damage their self-image and confidence, possibly
474:
children whose chest wall is compliant. Expert opinion suggests that the noncompliant chest wall malformation or significant asymmetry of the pectus carinatum malformation caused by a concomitant excavatum-type malformation may not respond to orthotic bracing."
266:. Pectus arcuatum is often confused with a combination of pectus carinatum and pectus excavatum, but in pectus arcuatum the visual appearance is characterized by a protrusion of the costal cartilages and there is no depression of the sternum.
336:
causing the sternum to protrude forward. It primarily occurs among four different patient groups, and males are more frequently affected than females. Most commonly, pectus carinatum develops in 11-to-14-year-old pubertal males undergoing a
1051:
518:
Pectus malformations usually become more severe during adolescent growth years and may worsen throughout adult life. The secondary effects, such as scoliosis and cardiovascular and pulmonary conditions, may worsen with advancing age.
500:
at the
Children's Hospital of the King's Daughters in Norfolk, Va. The Nuss is primarily used for Pectus Excavatum, but has recently been revised for use in some cases of PC, primarily when the malformation is symmetrical.
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disrupting social connections and causing them to feel uncomfortable throughout adolescence and adulthood. As the child grows older, bodybuilding techniques may be useful for balancing visual impact.
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457:
area of the chest produces excellent outcomes. Willingness to wear the brace as required is essential for the success of this treatment approach. The brace works in much the same way as
522:
Body building exercises (often attempted to cover the defect with pectoral muscles) will not alter the ribs and cartilage of the chest wall, and are generally considered not harmful.
614:
Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L (2009). "Imaging appearances of the sternum and sternoclavicular joints".
802:
Del Frari B, Sigl S, Schwabegger AH (2016). "Complications
Related to Pectus Carinatum Correction: Lessons Learned from 15 Years' Experience. Management and Literature Review".
510:
people with symmetrical pectus carinatum. Some try to hide the deformity under a layer of muscle by doing bodybuilding. But the deformity can reappear when training is stopped.
477:
Regular supervision during the bracing period is required for optimal results. Adjustments may be needed to the brace as the child grows and the pectus improves.
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770:
258:(also called type 2 pectus excavatum, chondromanubrial malformation or Currarino–Silverman syndrome or pouter pigeon malformation), which produces a
1029:
364:
Pectus carinatum is generally a solitary, non-syndromic abnormality. However, the condition may be present in association with other syndromes:
875:
493:
A modified
Ravitch technique uses bioabsorbable material and postoperative bracing, and in some cases a diced rib cartilage graft technique.
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1124:
541:, another pectus disorder, occurring in only about 20% of people with pectus malformations. About four out of five patients are
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should fail for whatever reason then surgery would be the next step. The two most common procedures are the
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In about 25% of cases of pectus carinatum, the patient has a family member with the condition.
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Congenital
Thoracic Wall Deformities: Diagnosis, Therapy and Current Developments
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Pectus malformations are rare; about 1 in 400 people have a pectus disorder.
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154:
872:"Pediatric Surgery | Mattel Children's Hospital UCLA - Los Angeles, CA"
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difficulties is serious enough to warrant a visit to a thoracic surgeon.
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776:. American Pediatric Surgical Association. 8 August 2012. Archived from
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304: in this section. Unsourced material may be challenged and removed.
203: in this section. Unsourced material may be challenged and removed.
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771:"Pectus Carinatum Guideline – Approved by the APSA Board of Governors"
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Kuzmichev, Vladimir; Ershova, Ksenia; Adamyan, Ruben (16 March 2016).
153:, is a malformation of the chest characterized by a protrusion of the
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The pectus carinatum can be easily diagnosed by certain tests like a
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897:"Pectus Carinatum, Cincinnati Children's Hospital Medical Center"
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353:. Least common is a pectus carinatum malformation following
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30:
Pigeon chest, pectus cavernatum, bird chest, convex chest
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675:
655:. Springer Science & Business Media. pp. 38–.
262:
and upper sternal protrusion, particularly also at the
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see if the brace is in correct position on the chest.
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84:
72:
69:
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55:
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727:
Desmarais TJ, Keller MS (2013). "Pectus carinatum".
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357:or in children with poorly controlled bronchial
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161:. It is distinct from the related malformation
1734:Congenital disorders of musculoskeletal system
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239:Some children with pectus carinatum also have
1045:
858:, How to fix Pectus Carinatum with exercises.
443:
254:A less common variant of pectus carinatum is
795:
720:
1052:
1038:
649:Anton H. Schwabegger (15 September 2011).
243:(i.e., curvature of the spine). Some have
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693:
320:Learn how and when to remove this message
219:Learn how and when to remove this message
678:"Surgical correction of pectus arcuatum"
866:
864:
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1033:
899:. Cincinnatichildrens.org. 2007-09-26
838:
349:) due to deposition of unmineralized
332:Pectus carinatum is an overgrowth of
168:
1573:Greig cephalopolysyndactyly syndrome
861:
302:adding citations to reliable sources
273:
201:adding citations to reliable sources
172:
13:
1063:malformations and deformations of
889:
874:. Surgery.ucla.edu. Archived from
804:Plastic and Reconstructive Surgery
14:
1745:
914:
504:
490:and the Reverse Nuss procedure.
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177:
42:
1246:Congenital patellar dislocation
1125:Wallis–Zieff–Goldblatt syndrome
537:Pectus carinatum is rarer than
529:
289:needs additional citations for
188:needs additional citations for
850:
763:
669:
607:
578:
1:
729:Current Opinion in Pediatrics
682:Journal of Visualized Surgery
571:
847:, Pectus Carinatum Exercise.
816:10.1097/PRS.0000000000002414
741:10.1097/MOP.0b013e3283604088
513:
438:
426:
406:multiple lentigines syndrome
7:
1532:Oto-palato-digital syndrome
1527:Hallermann–Streiff syndrome
1251:Congenital knee dislocation
1069:musculoskeletal abnormality
548:
480:
10:
1750:
1563:Craniodiaphyseal dysplasia
496:The Nuss was developed by
444:External bracing technique
1697:
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1649:
1640:
1595:
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1537:Treacher Collins syndrome
1507:
1479:
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1388:reduction deficits / limb
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26:
21:
1362:Cenani–Lenz syndactylism
1115:Cleidocranial dysostosis
695:10.21037/jovs.2016.02.28
1509:Craniofacial dysostosis
597:Oxford University Press
558:(convex, often healthy)
402:osteogenesis imperfecta
1065:musculoskeletal system
452:bracing, pioneered by
382:Ehlers–Danlos syndrome
1617:Klippel–Feil syndrome
593:UK English Dictionary
471:first line of therapy
414:mucopolysaccharidosis
245:mitral valve prolapse
1627:Spina bifida occulta
1143:Madelung's deformity
1120:Sprengel's deformity
628:10.1148/rg.293055136
408:(LEOPARD syndrome),
374:Loeys–Dietz syndrome
343:vitamin D deficiency
298:improve this article
197:improve this article
1445:RAPADILINO syndrome
1307:Rocker bottom foot
993:External resources
586:"pectus carinatum"
355:open-heart surgery
169:Signs and symptoms
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1642:Thoracic skeleton
1622:Spondylolisthesis
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783:on 9 October 2016
662:978-3-211-99138-1
566:(concave, sunken)
488:Ravitch technique
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16:Medical condition
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1689:Pectus carinatum
1684:Pectus excavatum
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1605:Spinal curvature
1597:Vertebral column
1517:Crouzon syndrome
1481:Craniosynostosis
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599:. Archived from
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539:pectus excavatum
386:Morquio syndrome
334:costal cartilage
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1440:Larsen syndrome
1428:multiple joints
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1236:Genu recurvatum
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1189:Hip dislocation
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810:(2): 317e–29e.
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370:Noonan syndrome
366:Turner syndrome
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1568:Dolichocephaly
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622:(3): 839–59.
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616:Radiographics
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345:in children (
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310:December 2016
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287:This section
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264:sternal angle
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209:December 2016
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186:This section
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122:
40:
39:
37:
35:Pronunciation
33:
29:
25:
20:
1688:
1553:Macrocephaly
1399:
1395:Acheiropodia
1367:Ectrodactyly
1287:
1268:
1153:Oligodactyly
1148:Clinodactyly
1077:Appendicular
1011:
1000:
976:
965:
950:
935:
901:. Retrieved
891:
880:. Retrieved
876:the original
852:
840:
807:
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785:. Retrieved
778:the original
765:
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722:
685:
681:
671:
651:
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619:
615:
609:
601:the original
589:
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555:Barrel chest
536:
533:
530:Epidemiology
524:
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459:orthodontics
447:
430:
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410:Sly syndrome
363:
339:growth spurt
331:
316:
307:
296:Please help
291:verification
288:
255:
253:
249:
238:
230:
215:
206:
195:Please help
190:verification
187:
151:pigeon chest
150:
146:
145:
1583:Saddle nose
1350:Webbed toes
1341:Polydactyly
1226:Genu valgum
1158:Polydactyly
1002:MedlinePlus
498:Donald Nuss
454:Sydney Haje
448:The use of
139:Orthopedics
27:Other names
1558:Platybasia
1494:Oxycephaly
1407:Phocomelia
1401:Ectromelia
1377:Stub thumb
1345:Syndactyly
1312:Hammer toe
1281:Pigeon toe
1231:Genu varum
1203:Coxa valga
1061:Congenital
978:DiseasesDB
903:2011-08-31
882:2011-08-31
806:(Review).
731:(Review).
572:References
394:trisomy 21
390:trisomy 18
1610:Scoliosis
1417:Hemimelia
1302:Pes cavus
1295:Flat feet
1276:Club foot
1208:Coxa vara
1013:eMedicine
514:Prognosis
439:Treatment
427:Diagnosis
418:scoliosis
260:manubrial
241:scoliosis
134:Specialty
1728:Category
1660:Cervical
1107:shoulder
1103:clavicle
1085:dysmelia
1018:ped/1803
824:27465193
787:17 April
757:46604820
749:23657247
714:29078483
636:19448119
549:See also
481:Surgical
450:orthotic
1675:sternum
972:D066166
832:5385408
705:5638405
433:CT scan
351:osteoid
347:Rickets
155:sternum
1698:other:
1412:Amelia
1289:valgus
1007:003321
961:754.82
830:
822:
755:
747:
712:
702:
688:: 55.
659:
634:
591:Lexico
359:asthma
270:Causes
234:asthma
125:
1665:Bifid
1546:other
1463:Axial
1270:varus
983:29402
946:Q67.7
828:S2CID
781:(PDF)
774:(PDF)
753:S2CID
543:males
1651:ribs
1218:knee
1094:Arms
1081:limb
967:MeSH
956:9-CM
820:PMID
789:2016
745:PMID
710:PMID
657:ISBN
632:PMID
159:ribs
157:and
1181:hip
1172:Leg
952:ICD
937:ICD
812:doi
808:138
737:doi
700:PMC
690:doi
624:doi
300:by
199:by
1730::
1343:/
1191:/
1105:/
1083:/
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