Morphogenesis of the manubrium of sternum in human embryos: a new concept

To revisit many theories on fetal development of the manubrium of the sternum, we examined 25 mid-term fetuses at 6-9 weeks of gestation. The initial developmental stage of the manubrium was characterized by a distinct interclavicular mesenchyme that was continuous with the developing clavicles. Because parts of the clavicle in which endochondral ossification occurs originate from the neural crest, the interclavicular mesenchyme seems to be of the same origin. The sternal bands, possibly of the lateral plate origin, were restricted at the anterior ends of the ribs in the paired thoracic walls. The interclavicular mesenchyme extended caudally and laterally to reach the anterior ends of the first ribs, and thus the interclavicular mesenchyme expanded into the intercostoclavicular mesenchyme. Then, the primitive manubrium was delimited by the sternoclavicular joint and its related ligaments, all of which developed from the interclavicular and intercostoclavicular mesenchymes. Although the first ribs were attached to the intercostoclavicular mesenchyme, the former was vimentin-negative in contrast to the latter, positive mesenchyme. Soon afterwards, the small upper end of the sternal bands was integrated into the intercostoclavicular mesenchyme to form the primitive manubrium. The infrahyoid muscles and their supplying nerves maintained a close topographical relation to the interclavicular or intercostoclavicular mesenchyme, whereas the pectoralis major muscle kept attachments to the sternal bands. Consequently, the manubrium of sternum appeared to develop in a complex way at a junction area between derivatives of the neural crest, lateral plate, and somite.