Sternal Cleft: About Three Cases

The sternal cleft or the bifid sternum is due to a defect of fusion of the sternum and its incidence is estimated to be 0.15% of all malformations of the thoracic cavity. The etiology of sternal cleft remains unknown. Primary closure in the neonatal period remains the unanimous recommendation. However, surgeons are faced with neglected slits that sometimes extend into adolescence. In this work, we discuss our management of sternal cleft in three patients compared to that reported in the literature. The first patient is a child aged 2 years and 6 months, admitted for a higher sternal cleft. Both clavicles were 54 mm apart with no other associated abnormalities. It benefited from a primary closure with good evolution. The second patient is a child aged 2 years and 8 months, admitted with an upper sternal cleft associated with vascular malformations and labial angioma. It benefited from a thymectomy plus primary closure with good evolution. The last patient is a child aged 2 years with a complete sternal cleft. She had a primary laparoscopic closure. The aftermath was marked by a partial recurrence of the suprasternal part which was resumed by classical surgery with a good evolution. Whether the sternal cleft is symptomatic or not, surgical treatment is recommended to protect the heart and large vessels from trauma on the one hand and to improve respiratory dynamics on the other. Primary closure is best during the neonatal period. The imminent risk of compression of the underlying organs, against indicates direct closure. Several processes are then proposed and all have the same objective: to gain in length and thus obtain a cover with the least risk of compression. In our patients, despite their ages, the defect lent itself to a primary closure without tension, which justified our therapeutic choice. It was possible by conventional surgery and laparoscopy. We admit that this primary closure can always be preferred when the residual compliance of the rib cage allows a closure without risk of compression of the underlying organs, whatever the age.