Hello,

My daughter had pectus excavatum (funnel chest) and sleep apnea. She had a tonsil/adenoidectomy on Monday. I have read several places where this surgery helps both the apnea and the sunken chest (in young children over a 2 year period the center of the chest rises up to it's normal position). Like sucking for air all night over the years pulled her chest wall in (sort of like sucking hard on a juice box until it crumples?) And opening the airway lets it return to it's normal position (over a long time).

Well, I have a burning interest in chest walls and apnea.

Do any of your children with apnea also have a dented chest wall? Any replies would be greatly appreciated.

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As to the surgery, it was a great success. Two nights before the surgery, I videotaped her sleeping. In only ten minutes I recorded several different 'scenes' including: 1. gasping, tilting head back 2. 3 apneas: blows out, breathes 3. apnea sucking--no air, gasping 4. labored breathing 5. apnea, gasping, chest sinks in 6. chest goes in ribs flair, no air goes in 7. repeated apneas, I shake her twice 8. labored breathing, chest sinks in 9. sucking sounds.  SCARY.

After the surgery, I also taped her: regular even breathing. A little snurgly because of swollen throat and gunk in there. Five days later, she's so quiet that I check to make sure she's breathing, and she is! Hooray! We used to hear her breathing no matter where we were in the house, loud and scary.

It was a 20 minute surgery and 3 day recovery. She's still a little draggy, and not eating too much, but almost back to normal.

But like I say, I am very, very interested in understanding the pectus excavatum (PE) now. So, please, how common is it in children with sleep apnea? Also I noticed the moderator casually mentioned that apnea is associated with PE, but on the pectusinfo.com message board they took it as controversial and suspicious. I would love to have more information on this. It makes a lot of sense to me, especially after watching my sleeping child's chest sink in. After the surgery, it rises like a normal person's (although the basic dent remains).


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Northern_grl

Hi, my daughter has the same problem, the sleep apnea with the sunken chest. She had adenoidectomy last august and the problem persisted, so now she is going for the tonsilectomy. But I'm very concerned about the chest, and I've been looking for information about it but I can't find anything.
Please let me know if you find more information about it.

Thanks,

HI,
I found your topic really interesting and very relevant to my 3 year old!!!
My son has a sunken chest that his resp consultants have always kept an eye on. He has obstructive sleep apnea along with a few other problems.  He had his T&As removed when he was 1 1/2 and over the next year his chest actually corrected quite a lot but now it is noticably deeper (his consultant actually commented on this yesterday-just been in hospital with paraflu) but it turns out that his T&As have grown back and are being removed again next month.

I could go on for ages about him - but I hear him coughing again so I better go!!

I recently did a web search on pectus and adenoid hypertrophy.  My 2-year-old daughter has large adenoids that cause mild OAS and has pectus excavatum.  I too watched her sucking for air and thought there must surely be a connection.

There are several publications in medical journals reporting a link between patients with upper airway obstruction and pectus.  I have only read the abstracts of the articles, so I don't have much detail on the age of the patients though they were clearly pediatric patients. A couple of the abstracts did indicate that removing T&A relieved the pectus.  Again, didn't read the full article, so I'm not sure of the timeframe for results.
 
Here is a link to one article on point. http://archpedi.ama-assn.org/cgi/content/abstract/135/6/550

Would love to hear if you note any improvement in the pectus over time.  We are on the fence about having her adenoids removed.

Hi,

I have been reading up about T&A's. Did anyone have the technique called "PITA?"

My daughter recently saw an ENT and he recommended a T&A based on her large adenoids (3+?), fatigue, snoring and bed-wetting.
I've read PITA is supposed to cut down the recuperation time, but it sounds sort of new. Was just curious how widespread it it and
if only certain docs do it, etc.

I have to have a second consult with the ENT to go into more detail, but was just curious about opinions.

He was not recommending a PSG because of her age, although the symptoms seem consistent with OSA.

Thanks,
Jenny

Hi,

Two and a half years later. My daughter still sleeps great at night. The dent in her chest has improved greatly. It used to look like someone had tied a string to it and pulled it really hard from the back (steep dent). Now it is almost flat, with an unremarkable dent off-center.

Her flared ribs are still flared, but if you place your hand over the lower ribs, I'd almost call it a normal chest. Hope this makes sense.

Here is a quote from the doctor who pioneered the Nuss Procedure for pectus excavatum:

"Children have soft and malleable chests. In young children, the chest is so soft that even minor respiratory obstruction can cause severe sternal retraction. Trauma rarely causes rib fractures; flail chest, etc., because “the chest is so soft and malleable.”21-23 The American Heart Association recommends “using only two fingers” when performing cardiac resuscitation in young children and “only one hand in older children” for fear of crushing the heart."

And the link to the page:

http://www.chkd.org/Services/NussProcedure/History.aspx

Sorry I took so long to write the results. Life is busy. Hope this helps someone.



Last edited by Northern_grl on Fri Oct 17, 2008 2:23 pm; edited 2 times in total
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Northern_grl

Oops--sent message twice.


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Northern_grl

Wow, your daughter recovered that fast? My daughter had a tonsil/adenoidectomy and tubes on Wednesday and she is still feeling like !@#!! Got any hints? lol


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Started CPAP 4/08, pressure 10
nights camping with CPAP: 11!

I thought Sarah was normal until my son had his out. He lost a few pounds over a week and a half (his pants were falling down), and he was in terrible pain for a few days, and then miserable for several more. Total, probably 10. Getting him to drink was very difficult. Milkshakes with a good quality ice cream (breyers--milk, cream, suger), so he'd get a little nutrition out of it, mixed with a generous amount of milk and spoon fed while he was watching tv and distracted.

Also, those candy spray bottles (very small and they come in sour or sweet, like a little aerosol/pump bottle) are supposedly juice flavored and the SWEET one kept him taking his yucky pain-killer medicine. Me: "take it quick and then the candy spray" He'd swallow the medicine and open his mouth. Squirt, squirt it in really quick and it wasn't so yucky. Around here you can buy them at the Meijer store (maybe kmart??) Definitely not the sour one. The spray killed the bitter taste, but didn't have to be swallowed, which would have hurt. It's like a dollar or something. Well worth it if you can find it.

And campbells chicken noodle soup broth (seemed healthier than popsicles? or at least more food-like). At some point, the popsicles and jello got really tiresome. I don't know how old your daughter is, but the spoon-feeding while distracted was the only time I could feed him (4 1/2). If he saw me coming, he'd refuse to open his mouth.

He was always able to pee; so if he got dehydrated, it wasn't too bad, I think. I was kind of alarmed at how little he seemed to be drinking.

Sarah was only in surgery for 20 minutes. My son was longer. I think hers was just an easier operation. Not sure, though.

He did gain the weight back, but it took a few weeks. Now (6 weeks later) he seems perfectly normal.

I'm sorry your daughter is so miserable. You think it's going to last forever, but then one day, she'll be hungry and eating won't hurt. She'll eat and drink and recover quickly once the pain eases. Just get through this part. It will pass.

Barbara


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Northern_grl

That's a good tip with the meds!  I think that's the worst part. She is also 4 1/2. I had to switch back to just plain old tylenol tonight though, because she has not had a bowel movement since before her surgery.

She refuses to eat anything except fruit snacks, and will only drink apple juice and sprite.   On the plus side, tonight is the first night that I haven't noticed her snoring anymore.

Thanks for the tips!


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Started CPAP 4/08, pressure 10
nights camping with CPAP: 11!

I just thought I would update, my daughter is doing SO much better. On day 9 I took her back into the doctor because I was so worried about her and he discovered she'd developed thrush. We got the meds for that and the next day she was like a whole new kid, back to her old self. She isn't snoring anymore, which is so weird for me. I keep checking on her to see if she's breathing.


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Started CPAP 4/08, pressure 10
nights camping with CPAP: 11!