Contents
Congenital deformity of the anterior thoracic wall in which the sternum and rib cage grow abnormally producing a caved-in or sunken appearance of the chest.

Aetiology
Associated conditions:
- Congenital disorders:
- Noonan syndrome
- Marfan syndrome
- Loeys-Dietz syndrome
- Connective tissue disorders:
- Ehlers–Danlos Syndrome
- Spinal muscular atrophy
- Develop pectus excavatum due to their diaphragmatic breathing
Clinical features
- Sunken appearance of the sternum (HALLMARK)
- Cup-shaped concavity, involving the lower end of the sternum (M/C form)
- Lower-most ribs may protrude (“flared ribs“)
- May be symmetric or asymmetric
- Chest and back pain
- Severe cases:
- Mitral valve prolapse

Diagnosis
Imaging:
Chest X-ray or CT-scan
Management
Conservative treatment:
- Excercise
Magnetic mini-mover procedure (3MP)
Technique used to correct pectus excavatum by using two magnets to realign the sternum with the rest of the chest and ribcage
Vacuum bell (treatment by cup suction) + physiotherapy

Surgical management: Ravitch technique
- Two-stage procedure:
- Creating an incision along the chest through which the cartilage is removed and the sternum detached
- Small bar is inserted underneath the sternum to hold it up in the desired position.
- Bar is left implanted until the cartilage grows back (~6 months), then removed in an OPD procedure

Nuss procedure
- Two-stage procedure:
- Slipping in ≥ 1 concave steel bars into the chest, underneath the sternum
- Bar is flipped to a convex position so as to push outward on the sternum, correcting the deformity.
- Bar usually stays in the body for 2-5 years
- Removed through OPD procedure when the bones have solidified into place
- Slipping in ≥ 1 concave steel bars into the chest, underneath the sternum

Robicsek procedure
- Single-stage procedure:
- Pectoralis major muscles then detached from the sternum
- Using the upper limit of the sternal depression as a guide, the deformed cartilages are removed one-by-one, using sharp and blunt dissection.
- Lower tip of the sternum is then grabbed with a towel-clip and, using blunt dissection, is freed of tissue connections with the pericardium and the pleura.
- Sternum is then forcefully bent forward into a corrected position.
- To keep the sternum elevated, a piece of mesh is placed under the mobilized sternum and sutured under moderate tension bilaterally to the stumps of the ribs.
- The pectoralis muscles are united in front of the sternum and the wound is closed.
