ROYAL AIR FORCE HOSPITAL. ADEN
COMPLETE median cleft or fissure of the sternum has been described by various observers, usually associated with defects of the neck and abdominal wall. The authors feel that the case to be described here, having no detectable abnormality other than the sternal deficiency and a superficial scar of the abdominal wall, is therefore worthy of record.
HISTORICAL SURVEY
Gibson and Malet1 (1879) described a case in which a sternal fissure existed in the cranial end of the bone as far downwards as the upper border of the fourth rib ; this was associated with a strong membrane attaching the sternal edge in the cleft to the cricoid cartilage, and a scar-like strip of skin, 3 in. long, passing upwards from the umbilicus. Professor Sir William Turner2 (I 879) described a specimen in the Anatomical Museum of the University of Edinburgh, with fissure of the sternum ending at the level of the seventh rib, where the two halves articulated in the mid-line. He quoted cases of Herr Groux, Skoda and Forster, the former describing, apparently, his own condition, and the latter found the ribs to be fused to the sternum without articulation.
Martin3 (1887) described a case in a new-born female, which he traced to be healthy to the age of 4& months, though with umbilical hernia, divarication of the rectus muscles, and attenuation of the skin of the precordial area.
More recently Barillet4 described a case in which the cleft was sufficiently large to permit examination and direct record of the aortic pulse. Benhamou, Hermann, and Levi-Valensij have described a case of apparent complete absence, as opposed to fissure, of the sternum, with records of cardiograms obtained directly through skin from the pericardial surface of the heart as far out as the apex. It is interesting to note that no cardiac abnormality could be detected.
The condition was exhaustively reviewed in 1922 by Alfred Szenes6 and in 1926 by Mr. David Greig, of Edinburgh.' Szene's case was a male aged 8 years, with complete fissure of the manubrium and body of the sternum as far as the xiphoid at the sixth costal cartilages. Scarred skin lined the fissure and a ligamentous raphe connected a spur-like protuberance of the chin with the sternal fissure, over which it spread fan-wise. This raphe caused a pouch-like fullness of the neck and limited extension of the head on the neck.
Morton and JordanY (1935) described a still further stage in a case of median cleft of the lower lip and mandible, cleft sternum, and absence of the basi-hyoid. In their case the sternal deformity consisted of apparent absence of the manubrium and upper half of the sternum, with the inferior gnathoschisis and the connecting area of scar tissue from the mental region to the floor of the sternal cleft.