Summary
Sternal clefts are rare malformations that result from a sternal fusion defect. Clefts located at any level of the sternum occur in approximately one baby in 50,000. So far, sternal clefts have been described in the literature in slightly more than 100 cases. Sternal clefts appear equally in males and females. They normally occur by the 9th week of intra-uterine life in the cranio-caudal direction and may be diagnosed at birth or later. In the long term, the cleft may lead to mild pectus excavatum. Sternal clefts are usually isolated, but have also been reported in association with facial hemangioma, webbed neck, malformations of the central nervous system and eye coloboma. Sternal cleft may represent a part of the Cantrell pentalogy, in which case associated malformations condition the prognosis. The aetiology is unknown. Rare familial cases have been reported for associated cases only. Management includes the following measures: primary closure of the sternal cleft should be performed in young infants to protect the heart and major vessels from trauma, to improve respiratory dynamics and for aesthetic reasons. In neonates, the sternal bars can be approximated by a simple suture, due to the flexibility of the cartilaginous thorax. There is also little danger of cardiac compression when the repair is performed early in life. If reconstruction is delayed, the increased rigidity of the chest wall and the physiologic accommodation of the thoracic organs to the circumference of the chest render simple approximation impossible without compromise of the heart and lungs. *Author: Orphanet (October 2005)*.
