Cleft sternum: Case report and literature review

Abstract

The isolated sternal cleft is a rare congenital anomaly that presents from birth to adulthood. We describe the late presentation and management in a child with this condition. The modern investigative and operative options are reviewed.

Imaging Appearances of the Sternum and Sternoclavicular Joints

“…Arthritides that may affect the sternoclavicular and manubriosternal joints include septic arthritis (discussed in "Infectious Processes"), osteoarthritis, rheumatoid arthritis, ankylosing such as ectopia cordis and pentalogy of Cantrell (30). Whereas axial CT images depict bars and clefts as midline abnormalities (Figs 5, 6a), reformatted coronal images better demonstrate the lucent defects corresponding to clefts ( Fig 6b) and the longitudinal orientation of sclerotic bands (10).…”

Sternal cleft, Morgagni hernia, and ectopic liver: a unique chest wall anomaly

“…Diagnosis in the neonatal period presents a surgical opportunity for primary closure of the sternum without autologous or prosthetic grafts, owing to a very compliant and flexible chest wall [1][2][3]. Missing this opportunity typically leads to more complex repairs involving chondrotomies, autologous tissue, or prosthetic grafts in older children [3][4][5]. In our case, sternal reconstruction was rather easily performed by mobilizing the sternal bars and closing them primarily followed by approximation of the pectoralis muscles.…”

“…However, late presentations have also been reported [3][4][5]. Diagnosis in the neonatal period presents a surgical opportunity for primary closure of the sternum without autologous or prosthetic grafts, owing to a very compliant and flexible chest wall [1][2][3].…”

“…Although the true incidence is unknown, less than 100 cases, mostly in the form of case reports or small case series, have been reported in the literature [1][2][3][4][5]. An electronic database search revealed a single case report of a neonatal sternal cleft associated with an extrathoracic mass [1], as well as a single case of ectopic liver tissue protruding through a sternal defect [6].…”

Thymectomy to achieve primary closure of total sternal cleft

“…To reduce this risk and achieve a successful closure in difficult cases, different techniques have been described such as sliding chondrotomies [2], or the creation of a posterior sternal wall with periosteal flaps [14]. Another option is represented by the closure with prosthetic or autologous materials [14][15][16][17]. However, this solution is less attractive-apart from the risk of infection …”