The maximal protrusion is at the sterno-xiphisternal junction or a little higher, and there is usually some pinch- ing-in of the lower costal cartilages [Fig. 48.2]. Prominence of the costal cartilages on each side near their junction with the sternum may be present, forming a median trough that, though locally depressed, is still part of the sternal protrusion. Rotation of the sternum producing an asymmetrical deformity is not uncommon. Radiography is necessary to confi rm the degree of pro- trusion and to exclude the presence of any intrathoracic condition which might be contributory. The symptoms are related entirely to the cosmetic defect, or to any under- lying condition. Treatment Secondary deformities usually resolve spontaneously after elimination of the underlying cause. Many primary lesions also show a tendency to spontaneous improve- ment. In the fi rst decade of life, repeated observation will indicate the trend. Many patients present for the fi rst time after puberty. Surgical correction is considered for patients with severe and/or progressive cosmetic deformity. Defi ciency deformities In the usual type, the pectoral muscles are absent on one side and there is a variable degree of hypoplasia of the underlying ribs and costal cartilages. The third and fourth cartilages may be defi cient anteriorly, with some paradoxi- cal respiratory movement visible through the chest wall, although this is rarely of any clinical signifi cance. All ele- ments of the breast may be absent, but usually the nipple and areola are present. Hypoplasia of the upper limb on the affected side and syndactyly may occur (Poland syn- drome; Fig. 48.3). The sternum in these patients may show a high protrusion deformity of cosmetic signifi cance. The dominant problem, however, is the soft tissue defi ciency. Treatment Surgery is only rarely indicated for fi lling in the bony chest wall defi ciency or for correction of sternal protru- sion. Muscular fl aps, utilising the latissimus dorsi can be used to provide soft tissue bulk, to be followed in girls by augmentation mammoplasty. It is more diffi cult to replace absent tissues than it is to reorganise disordered tissues; despite this, much can be done to improve the appearance in the
Posted on: Sun, 01 Jun 2014 13:17:26 +0000
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