Association between the pectoral muscles and rib anomalies in poland syndrome

Introduction: The purpose of this study was to investigate the relationship between pectoralis major muscle (PMj) and rib defects in Poland syndrome (PS) and to evaluate the clinical findings and variabilities by the systematic review of all/current published articles on PS. Material and Methods: Based on our inclusion criteria, 86 patients were decided to be eligible for participating in this study. The data of the reviewed studies were classified according to the date of publication, age, sex, side of the deformity, defect type of PS, presence of other muscle or chest wall abnormalities, and dextrocardia. Further, other coexisting deformities and abnormalities were recorded. A logistic regression statistical analysis was carried out. Results: According to the reviewed cases, both left-sided presence-multiple muscle defects and left-sided presence-rib anomalies were found to be statistically significant (P = 0.007 and P = 0.04, respectively). The strength of the relationship between these two parameters was evaluated by binary logistic regression analysis, which revealed that multiple muscle defects and rib anomalies were associated with left chest side presence (P = 0.005 and P = 0.02, respectively). When the relationship between rib anomalies and PMj defect was analyzed, the association was found to be statistically significant (P = 0.03). Furthermore, the result of the strength analysis was also supported this association (P = 0.04). Discussion and Conclusion: Molecular and embryological development processes of the ribs and pectoral muscles are investigated to assess the presence of a structural relationship considering the causal connection between ribs and PMj in PS. As a supportive element to our study, the presence of a myogenic regulatory factor-Hox gene link was asserted in the animal experiments done by some researchers, showing a common development process of the rib and pectoral muscle. We believe that with the outcomes of this study, the clinical diversity and the etiopathogenesis of PS could be explained comprehensively.