Superior sternal cleft: construction with a titanium plate

Sternal cleft is a rare congenital deformity, with a superior cleft being the most common. Although sternal clefting is known to be associated with vascular dysplasia, to our knowledge, we report the first case of superior sternal cleft with cervicofacial hemangiomata and cardiac defects in the absence of true ectopia cordis in a neonate. Early surgery in all cases of sternal clefting is advocated, preferably within the first 4 weeks of life. However, if the child is unfit for operation at this stage, repair should be carried out as soon as the child is stable and fit. The method of choice is primary approximation with the intraoperative precaution of confirming cardiorespiratory stability. We suggest reinforcing the primary approximation with a titanium plate to achieve rigid internal fixation and to reduce the tension at the approximation site. Because titanium osseointegrates well, this procedure results in a solid bony sternum.