A sternal cleft is a rare congenital anomaly where the breastbone fails to fuse properly during fetal development. Because the integrity of the rib cage is compromised, he heart may entirely lack skeletal protection. The cause of this condition is still unknown, but understanding the pathogenesis of sternal clefts is crucial for patients to choose the most effective surgical procedure.
Embryology and Formation
During embryonic development, the sternum originates as two longitudinal bands of mesenchyme, known as sternal bars. Between the sixth and tenth weeks of gestation, these bars normally migrate toward the midline and fuse in a cranial-to-caudal direction to form a continuous sternum. Failure of this fusion results in a partial or complete sternum cleft. Although sternal cleft can occur as an isolated anomaly, it may also be accompanied by other malformations. For example, complete sternal cleft is often accompanied by pectoral muscle deficiency, pericardial absence, and various other visceral anomalies. In contrast, inferior sternal cleft (a subtype of incomplete sternal cleft) is typically associated with the Cantrell pentalogy, which involves malformations of the sternum, diaphragm, pericardium, abdominal wall, and cardiovascular system.
Clinical Manifestations and Treatment
The symptoms of sternal cleft vary depending on the type and associated anomalies. Isolated sternal cleft is very rare. When it is not accompanied by other conditions, it typically presents only with abnormalities of respiratory or circulatory system function. Incomplete sternal clefts may be almost asymptomatic if the defect is small, but larger defects or those accompanied by other abnormalities can cause significant problems. Complete sternal clefts may be accompanied by cardiac ectopia, severely affecting cardiac function, and the condition is even more critical if there are congenital heart defects. Sternal cleft of the lower sternum is relatively severe and often occurs alongside Pentalogy of Cantrell. Affected infants may be critically ill and, in some cases, may die prematurely.
At The Institute of Chest Wall Surgery (ICWS), patients with a sternal cleft can choose surgical treatment to restore the chest wall and protect internal organs. For small gaps between the sternal edges, the cleft can often be closed directly without putting significant pressure on the heart or other mediastinal structures. For larger defects or rigid gaps, chest wall reconstruction is typically performed using the patient’s own ribs, while MatrixRIB bars are used to repair the rib defects and stabilize the chest wall.
Choosing a Path Toward Protection
For those seeking a definitive solution for a congenital chest gap, consulting a qualified specialist can help outline appropriate surgical options. Advanced reconstructive techniques may help restore chest wall stability and provide protection for the heart and other internal organs.
