Management and Surgical Repair of Neonatal Sternal Cleft: A Case Report of Two Successful Interventions.

Abstract

The sternal cleft(SC) is a rare congenital anomaly characterized by a complete or partial separation of the sternum, leading to significant clinical concerns, including respiratory and cardiac instability. Due to its rarity, the SC often poses surgical challenges. This case report highlights the management of two neonates with SCs, emphasizing the critical role of early multidisciplinary intervention. The first patient, a neonate, was born with a severe sternal deformity identified as a partial superior SC with a supraumbilical raphe. The patient was transported to a tertiary care center for further evaluation and management by a multidisciplinary team. Similarly, the second patient, another neonate, presented with similar sternal changes. Both patients were assessed for potential complications associated with sternal instability. The treatment involved surgical correction by closing the gap of the SC for both patients. The procedure included a midline skin incision, dissection and lateral reflection of the pectoralis major muscle, resection of cartilaginous plates for healthy cartilage fusion, and extension of the cleft through the manubrium to achieve anatomic closure by approximation and suturing. Intraoperative monitoring ensured the stability of cardiac and respiratory functions. Postoperative outcomes were favorable, with both patients recovering well and being discharged without complications on postoperative days 5 and 9. These cases highlight the significance of early surgical intervention with multidisciplinary management in neonates with SCs. The successful outcomes underscore the effectiveness of surgical intervention in preventing possible complications, ensuring rapid recovery, and stabilizing the chest. Further research into long-term outcomes and potential genetic factors may provide deeper insights into the management of this rare condition.