McMaster Children’s Hospital recently introduced innovative nerve freezing technology in surgery to correct the bowl-shaped cavity in the chest caused by the pectoralis excavatum, a defect that causes the sternum to collapse. Until this technology was introduced, this surgery required a long and painful recovery. Performed by a pediatric surgeon, the large team supporting this procedure includes residents, fellows, anesthesiologists, registered nurses, nurse practitioners, and physical therapists.
Mississauga teen Brandon Phillip was interested in an elective surgery to correct the bowl-shaped cavity in his chest caused by his pectoralis excavatum, a defect that causes the sternum to cave in. This abnormality did not threaten his health, but it added 17 years to his life. Older people are often self-conscious and questioned by other children.
Brandon Phillip, MCH patient
After meeting with Dr. Mark Walton, a pediatric surgeon at Hamilton Health Sciences McMaster Children’s Hospital (MCH), and learning that recovery would be long and extremely painful, Brandon decided to undergo treatment. I chose not to proceed.
“I perform a lot of surgeries, but this one is the most painful in terms of recovery,” Walton always warned his patients and their parents.
innovative technology
However, a few months later, Brandon changed his mind and booked another appointment with Walton. The timing was perfect, as MCH had just introduced an innovative nerve freezing technology specifically for this procedure that was highly effective in managing patients’ postoperative pain.
“Knowing that this pain management was available definitely made the decision to move forward easier.” — Brandon Phillip, Patient
“The cryo-nerve block technology was a game-changer,” Walton said, adding that the technology was introduced at MCH in January. Brandon underwent surgery in March and is recovering well at his home.
“Knowing that this pain management was available definitely made the decision to move forward easier,” Brandon says. He was still in pain after surgery, but it was manageable and he was able to walk the next morning. This was not possible before cryo-nerve block.
Brandon’s parents were relieved to learn that he would have a more manageable recovery. “As a parent, you worry about your child having surgery. An elective surgery is a big decision, but the team at McMaster Children’s Hospital made me feel so at ease,” says her mother, Cheryl.
Walton and pediatric surgeon Dr. Michael Livingston have performed the procedure on five patients since the technology was introduced. They are supported by a large team including residents, fellows, anesthesiologists, registered nurses, nurse practitioners, and physical therapists.
What is pectus excavatum?
In pectus excavatum, the sternum sinks into the chest, creating a bowl-like hole. This usually becomes more noticeable as you get older, and may be especially noticeable in tall, lanky teens. This is most common in boys, but some girls also have this abnormality. The surgery is performed for cosmetic reasons, as it rarely causes complications such as pressure on the heart or lungs.
Dr. Mark Walton, HHS Pediatric Surgeon
“The main issue is often the teen’s body image and self-esteem,” says Walton. “The psychological impact of having this type of abnormality is often underemphasized, but correcting it can make young people feel much better about themselves.”
Brandon’s chest dimples became visible when he was 13 years old. It grew and deepened as he grew taller. Brandon wasn’t teased, but the kids were curious. “In situations like swimming, where I take my shirt off, they’ll notice,” Brandon said, adding that he found even swimming lessons difficult. “My swimming instructor tells me to keep my chest above the water when swimming on my back, but my bowl fills with water and starts to sink.”
Neural freezing technology is a game changer
Surgery to correct pectus excavatum involves inserting a metal rod under the sunken sternum to force it back into its normal position.
“We have been performing this surgery at MCH for decades, and the challenge has always been the amount of pain patients experience during the long recovery period of approximately three months,” Walton said. he says. Before the introduction of cryo-nerve blocks, patients could spend up to five days in the hospital after surgery and then continue their slow and painful recovery at home for several weeks.
Surgery was often scheduled for the summer, so patients had time to recover without missing much school. Parents often had to take long breaks from work to care for their children, and they were prescribed multiple medications, including morphine, to manage the pain.
Now, by using frozen nerve blocks, patients can go home the day after surgery with manageable pain that turns into numbness until it completely disappears after a few weeks, and after about three months, patients can go home including contact sports. You will be able to begin normal activities.
How to use
In a cryo-nerve block, a special probe is used to freeze the nerves under the ribs in the chest, which are the main cause of pain after surgery. The technology’s unique freezing method blocks nerves from transmitting pain signals for several months.
It takes about 16 hours for these nerves to completely freeze, so a nerve block will be used by the anesthesiologist to manage postoperative pain during the first day after surgery. “By the time the effect wears off, the cryo-nerve block has taken effect and the nerve is frozen,” Walton said. Instead of constant pain, patients experience numbness, which fades over time as the nerve grows.
The hospital recently acquired a special retractor that helps lift the sternum and creates more space to pass a metal rod into the chest cavity in front of the heart, making the surgery even safer.
“I’ve been doing this surgery for many years and never had a problem, but there have been cases elsewhere where the heart has been damaged during this procedure,” Walton said. “So the retractor is another really great innovation for our team.”
Brandon said he felt some pain immediately after the surgery, but it subsided after three to four hours. She felt some pain at home for a few days after the surgery, but it was manageable.
“And now I’m definitely feeling numb,” Brandon says, adding that he’ll be able to go back to school in a few weeks, and once he’s fully recovered in three months, he’ll be back training at the gym and playing basketball with friends. I’m looking forward to doing that.
