Sternal cleft

Sternal cleft, also known as sternal fissure or cleft sternum, is a rare congenital malformation of the anterior chest wall in which the sternum (breastbone) fails to fuse completely during embryonic development. Normally, the two sternal bars migrate toward the midline and fuse between the 7th and 10th weeks of gestation; failure of this process results in a partial or complete midline defect of the sternum. The condition primarily affects the musculoskeletal system and can leave the heart and great vessels inadequately protected beneath only skin and soft tissue, creating a visible pulsation in the anterior chest. Sternal clefts are classified as complete (involving the entire sternum) or partial, with partial superior clefts being the most common subtype. Clinically, affected individuals present at birth with a midline defect of the chest wall, often with a skin-covered gap through which cardiac pulsations are visible and palpable. The defect may be associated with other midline developmental anomalies, including cervical or facial hemangiomas, supraumbilical raphe, and in some cases may form part of broader syndromic presentations such as Cantrell pentalogy or PHACES syndrome. Respiratory difficulties may occur in some patients, particularly those with complete clefts, due to paradoxical chest wall movement. Treatment is primarily surgical, and early repair in the neonatal period is strongly recommended because the chest wall is still flexible and pliable, allowing direct primary closure of the sternal halves. In older children and adults, the rigidity of the chest wall may necessitate more complex reconstructive techniques, including the use of autologous grafts, prosthetic materials, or sliding chondrotomy procedures. Outcomes following early surgical repair are generally excellent, with good cosmetic and functional results. Long-term follow-up is advised to monitor chest wall growth and cardiac protection.

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