PMC5553486_01
Front view of the child's chest before the first operation.
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Our little patient was with bilateral depression of the chest from the fourth to eighth rib, from the sternum to the anterior and midaxillary line ( Figs. 1 and 2 ).
Left lateral view of the child's chest before the first operation.
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Our little patient was with bilateral depression of the chest from the fourth to eighth rib, from the sternum to the anterior and midaxillary line ( Figs. 1 and 2 ). X-ray follow-up examination 3 months later showed progression of the deformity with the appearance of chest deformity and computed tomography (CT) image of lung compression ( Figs. 2 - 4 ).
Three-dimensional reconstruction computed tomography scan of the chest 5 months before the operation; left lateral.
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X-ray follow-up examination 3 months later showed progression of the deformity with the appearance of chest deformity and computed tomography (CT) image of lung compression ( Figs. 2 - 4 ).
Computed tomography scan of the chest 5 months before the operation demonstrates the lung compression.
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X-ray follow-up examination 3 months later showed progression of the deformity with the appearance of chest deformity and computed tomography (CT) image of lung compression ( Figs. 2 - 4 ).
Contoured mandible locking plates used in the first operation.
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We resected the deformed ribs (fifth to eighth) bilaterally and fix them with locking plate contoured in a "crown" shape and two shorter plates situated at both sides to sustain the resected ribs bilaterally ( Fig. 5 ).
Three-dimensional reconstruction computed tomography scan of the chest after the first operation; anteroposterior view.
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Postoperative X-rays showed excellent ribs position and good chest symmetry ( Figs. 6 and 7 ).
Three-dimensional reconstruction computed tomography scan of the chest after the first operation; axial view. Note the restored anterolateral contour of the chest.
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Postoperative X-rays showed excellent ribs position and good chest symmetry ( Figs. 6 and 7 ).
Front view of the child's chest before the second operation.
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During the next 3 months, the upper part of the previously nonfixed, but resected ribs started inward growing fast, forming the typically "bell" shape chest ( Fig. 8 ).
Front view of the child's chest immediately after the second operation (correction of the bell-shaped chest wall).
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That was the indication for our second operation. Through direct skin approach, we made chevron shape resections of the deformed ribs at two points ( Fig. 9 ).
Three-dimensional reconstruction computed tomography scan of the chest after the second operation; anteroposterior view.
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We used two short mandible locking plates placed anterolaterally for the ribs' fixation ( Fig. 10 ).
Front view of the child's chest 9 months after the second implant removal operation.
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The appearance of the chest is symmetric vertically and horizontally ( Figs. 11 and 12 ).
Lateral view of the child's chest 9 months after the second implant removal operation.
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The appearance of the chest is symmetric vertically and horizontally ( Figs. 11 and 12 ).