Sternal cleft repair: A report of two cases and review of literature

Abstract

A cleft sternum is a rare congenital anomaly often diagnosed as asymptomatic at birth. Clinical outcome may be unfavourable when an associated anomaly, particularly, an intra cardiac anomaly coexists with the defect. Primary repair should be employed in the neonatal period because the flexibility of the chest wall is maximal and thus the compression of underlying structures is minimal. However, patients with sternal cleft may even present late in the childhood or adolescence period. We herein report two cases of successful repair of sternal clefts with review of the available literature.

A Three Month-Old Girl with Cleft (Bifid) Sternum and Hemangioma of the Face

“…The first report of a successful surgical cleft sternum in an eleven-week old child was published in 1947 by Burton (6). Because of the high flexibility of the chest wall of newborns, the primary closure is easier to perform and the risk for cardiovascular impairment is decreased (7). If the patient presents later in life, reconstruction surgery is required because a simple approximation is impossible due to increasing rigidity of the chest wall and difficulting in accomodating the heart and lungs within the chest cavity (8).…”

Surgical Repair of a Superior Sternal Cleft in an Infant

“…To restore the protective function of the skeleton by establishing bony integrity as soon as possible and to benefit from the high flexibility of the chest wall in newborns, surgical repair should be performed in the first weeks of life. 3 4 5 …”

“…Different surgical techniques such as primary closure, bone graft interposition, prosthetic closure, muscle flap interposition, and others have been described. 3 4 5 6 7 8 …”

Incidental detection of superior sternal cleft on Technetium-99m methylene diphosphonate bone scan

“…[1] It results from failed ventral midline fusion of the sternal bars, which normally occurs during the first 3 months of embryonic life. [12] Isolated sternal cleft without any associated anomaly is very uncommon and presents in early infancy because of the obvious cosmetic deformity. [1] The anomaly is more common in females.…”

“…[12] Isolated sternal cleft without any associated anomaly is very uncommon and presents in early infancy because of the obvious cosmetic deformity. [1] The anomaly is more common in females. [3] We report an extremely rare case of isolated upper sternal cleft in an adult male patient, found incidentally on technetium-99m (Tc-99m) methylene diphosphonate (MDP) bone scan.…”