Neonatal sternal cleft associated with an extrathoracic cystic mass

Successful surgical repair of a sternum cleft using composite mesh: A case report and new technical note

Sternal clefts are infrequent congenital malformations, particularly in their complete presentation. There are less than 100 descriptions of these defects published in the literature worldwide. We report a clinical case of lower sternal cleft associated with congenital laparoschisis in a 2-year-old boy. Surgery was performed because of recurrent pneumopathy and the risk of cardiorespiratory decompensation in the midterm. A semi-resorbable prosthesis was used for sternal closure. We have not observed any complications with this sternal closure system in our patient. This approach is easy, safe, effective and not harmful to a child's growth.

Phenotypic spectrum and management of sternal cleft: literature review and presentation of a new series

Sternal cleft is a chest wall malformation that can expose mediastinal viscera and vessels to injuries. It can be classified into two forms, complete and partial. Its etiology and incidence are unknown and it is often associated with other defects. The aim of this article is to review the literature and report our experience with this rare anomaly, focusing on clinical presentation and management. We reviewed the English written literature about sternal cleft and collected the clinical data of all the published series. We present seven new cases that we have observed and treated since 1999. Literature reports 51 series including 86 patients, more frequently female (62%) and affected with partial superior form (67%). Sternal cleft is often asymptomatic (74%) and associated with other defects (72%). Surgical treatments include primary closure (73%), bone graft interposition (10%), prosthetic closure (7%), and muscle flap interposition (3%). In our series, primary closure was possible in four cases, while in three cases we placed a prosthesis. Five patients had associated defects and two were affected with PHACES (posterior fossa abnormalities, hemangiomas, arterial lesions, cardiac abnormalities/aortic coarctation, abnormalities of the eye, and sternum defects) syndrome. We report for the first time the association of sternal cleft with connectival nevi in three of our patients. At follow-up, we observed no major complication or recurrences. Although primary closure is the preferred option and should be performed in the neonatal period, the use of prostheses warrants good results as well. Prior to treatment, associated defects and syndromes should be excluded.

[Sternal cleft: repair during the neonatal period]

Sternal cleft is a rare congenital abnormality. We report on a neonatal case of sternal cleft with median raphe with a follow-up of 3 years. We review the advantages of surgical repair in the neonatal period because the flexibility of the chest wall is maximal and compression of underlying structures is minimal.

Thymectomy to achieve primary closure of total sternal cleft

Total sternal cleft is a rare congenital malformation that may represent a challenge for the surgeon. In neonatal period, the primary closure is usually achievable, but at older age, this can be impossible. Moreover, the closure of the 2 sternal bars can bring to an exaggerated compression on mediastinal structures. Many different techniques for the treatment of sternal clefts have been reported in literature. We describe one case of total sternal cleft repaired at 4 months of age in which a partial thymectomy was performed to achieve the primary closure. We suggest considering this simple procedure in selected patients to reduce the risk of mediastinal compression.

Embryology, sternal clefts, ectopia cordis, and Cantrell's pentalogy

Sternal clefts, ectopia cordis, and Cantrell's pentalogy continue to be very rare congenital anomalies in pediatric surgery. Unfortunately, these conditions present as neonatal emergencies and demand early surgical intervention. This article reviews the embryological development of the chest wall, specific sternal defect anomalies, along with available methods of treatment.

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

Sternal clefts are rare chest wall anomalies which may occur in isolation or in association with cardiac, pericardial, and diaphragmatic defects. We present the first report of a unique chest wall anomaly consisting of a triad of sternal cleft, anterior diaphragmatic hernia, and ectopic, exophytic liver tissue. A partial diagnosis was made on prenatal ultrasound imaging and computed tomography imaging of the baby's chest, but the full extent of the anomaly was only identified at operation. Full repair was completed on the third day of life with excellent outcome.

Sternal cleft: a surgical opportunity

PURPOSE

The aim of this study was to evaluate the results from the surgical techniques utilized to repair congenital sternal cleft.

METHODS

From January, 1987 to January, 2001, 5,182 patients were seen for chest wall malformations. Eight (0.15%) had sternal cleft. The age at presentation ranged from 15 days to 5 years. Six were girls (75%). The associated malformations were congenital cardiac malformations (2 patients), maxillofacial hemangioma (1 patient). All of them underwent a surgical repair, which could be classified into 3 methods: group 1 had primary closure of the defect (3 patients); group 2 underwent partial resection of the first, second, and third costal cartilages, disruption of the sternoclavicular junction, and closure of the sternal bars with stainless steel wire (3 patients); and group 3 had mobilization and approximation of the sternocleidomastoid muscles with closure achieved with costal homograft and prosthetic mesh (2 patients). The interval for postoperative follow-up was 1 to 8 years.

RESULTS

Group 1 patients developed well, although 2 of them had a slight degree of pectus excavatum in the long term not requiring surgical correction. Group 2 Patients developed without problems in all cases. One of the patients from group 3 had unsatisfactory aesthetic and functional results. He underwent reoperation with the second technique, achieving an improved result.

CONCLUSIONS

Primary closure of the sternal cleft is the easiest technique. It should be performed in young infants. In the long term it can lead to a mild degree of pectus excavatum. The costal cartilage resection with mobilization of the clavicle achieved excellent results and allowed ready approximation of both sternal halves avoiding the use of costal grafts and prosthetic material.