It is the most rare type of congenital chest wall deformities. While carinatum deformity is seen on one side, excavatum deformity may be accompanied on the other side. A group of deformities of this type is also called pectus arcuatum (Chondromanubrial). "Chondromanubrial" deformities are the most rare form of pectus. In this form, which is typically called pigeon chest deformity, the protrusion occurs in the upper part of the sternum (iman board) with the cartilaginous costas on top, the lower part of the sternum looks collapsed. Heart anomalies are more common in this type. Apart from pectus arcuatum, this group of deformities are also seen as mixed-type asymmetric and mixed-type symmetrical deformities. Although less common than other types of pectus, myxdeformities are the most difficult form, both in terms of diagnosis and treatment. Typically, mixed deformities are a combination of both excavatum and carinatum. The incidence rate of mixed type pectus deformities is around 14 per thousand.

It's reason

 

The cause of deformities of this form is not fully explained. It is characterized by the displacement of the sternum forward and protrusion forward with excessive growth of the costal cartilages. It often occurs immediately after birth.

 

 

It mostly does not give symptoms, except for image impairment. Children who are uncomfortable with the appearance of the rib cage avoid going to the sea, the pool and physical education classes.

 

 

In this form, too, a physical examination is often sufficient for doctors in the diagnosis. A specific blood test, etc. there is none, but the severity of the deformity can be determined by radiological evaluation. Computed Tomography (CT) and Magnetic Resonance (MRI) are imaging methods that can be used.

 

 

The Abramson procedure, which is highly effective in symmetrical deformity, does not provide a very effective improvement in mixed deformities. Correction with open surgical techniques is still more preferred in these patients. However, “open surgery” is not the only option for the treatment of mixed-type pectus deformities, which are much rarer than Pectus excavatum and carinatum deformities. The combination of closed surgical techniques in other deformities can only be applied in asymmetric and symmetrical mixed deformities. There are two types of surgical techniques in this area:

 

The sandwich technique developed by Park is one of them. In order to correct the collapse, steel bars are installed under the sternum and over the sternum to suppress the protrusion in order to provide treatment. This method gives shape to the anterior chest wall by pressing it between two bars and provides effective Deceleration. When Park first developed the technique, he first placed the bar behind the bone and then the bar in front, over time, he changed the technique and began to place the bar first in front (carinatum bar), then in the back (excavatum bar). When starting the surgical intervention, the highest point of the carinatum deformity and the most hollow point of the deformity are marked. To determine the most hollow point, it is necessary to press on the highest point of the carinatum deformity and observe the shape change in the deformity and determine the deepest point. The operation is performed after the lines to be crossed by the bars are determined. At the end of the operation, the excavatum bar and the carinatum bar are attached to each other. In this way, the ideal shape is given to the chest wall in asymmetric pectus carinatum and appropriate mixed pectus carinatum – excavatum deformity. Bars are removed no later than in two years. The sandwich technique proposed by Park, Prof. Dr. It is also successfully applied by Mustafa Yuksel. So far, high patient satisfaction has been achieved in sandwich surgery performed on 50 patients.

 

Applied in pectus arcuatum Dr. The open surgical correction described by Önen can be summarized as a technique consisting of a combination of the Nuss procedure with the technique using titanium plates and screws applied by Wang for pectus carinatum. At the level where the carinatum deformity is most protruding, the bone is almost “rasped”. This procedure is called “wedge osteotomy with an oscillatory sternum saw”. The wedge osteotomy line is fixed with a titanium plate and the pectus bar is placed at the level where the excavatum is the most depressed. In this procedure, which lasts about an hour on average, there are no large incisions like in ravitch and similar surgical techniques, and therefore it provides advantages such as postoperative recovery time, etc. The cosmetic results are also laughable. The placed bar is monitored for about 1 year, then withdrawn. With its low complication rates and high patient satisfaction levels, this method can also be preferred in the surgical treatment of patients with mixed pectus deformity, especially pectus arcuatum type.