Sternal Cleft
Sternal cleft is a rare anomaly that can be defined as defects of different length and position in the midline of the sternum (iman board). Idiopathic congenitalityis a congenital defect, the cause of which is unknown. It is a condition that develops as a result of insufficiency at the junction of the sternum. Two types have been described. It is a disease with a good course due to the absence of heart anomalies. Surgical repair is performed with the aim of protecting the heart and large vessels from injury, improving the dynamics of breathing, eliminating cosmetic concerns.
It's reason
The factors in the occurrence of the disease have not been fully established. 6-9 of pregnancy. it is believed that it occurs as a result of a cause that affects the development of mesodermal (middle skin in the fetus) structures during the weeks. Cleft rib cage is the most common type. it occurs once in 50 thousand to 100 thousand live births and accounts for 15 out of a thousand of all anterior chest wall deformities. Several factors such as methylcobalamin (vitamin B12) deficiency, excessive alcohol use during pregnancy, and a disruption in the HOX-B4 gene have been identified in mouse models.
Symptoms
In sternal cleft, the defect is mostly on the upper side and the heart is in its normal place. The skin is often intact. Dysfunction of the heart occurs due to the fact that during the baby's crying, the heart bulges out of the slit. More rarely, the cleft can also be seen in the lower part or in the total.
Diagnosis
The diagnosis of sternal cleft is usually made by physical examination during the neonatal period. Imaging methods, on the other hand, are useful in identifying October problems. Due to the fact that the disease can be asymptomatic, its follow-up may take from the newborn to adulthood. Most often, patients turn to the doctor with complaints of pectus deformity. If surgical treatment is not performed, a sail chest (flail chest) is formed in patients, which creates impaired gas exchange. This in turn causes respiratory symptoms such as dyspnea and cough, or frequent lung infections may develop.
Apart from these many diseases that are associated with the syndrome and other diseases therefore is subject to the accompanying radiograph in addition to introducing the components of the disease, blood count, computed tomography (CT), magnetic resonance imaging (MRI), electromyography (EMG), echocardiography and abdominal ultrasound of the implementation will be in place. CT also allows for the planning of the treatment to be applied.
Treatment
Cases where the integrity of the skin is also impaired should be operated immediately. Cases where the skin is healthy can be corrected in elective conditions. Correction should be carried out in the neonatal period. In the corrections made during this period, there is no squeezing in the heart. Cartilage grafts can also be used for correction at a later age. The first-line treatment is the surgical closure of the defect in the neonatal period. In the pre-surgical examination, the focus should be on common associated malformations (defective structures), in particular cardiac defects. Early repair gives better results. The lack of bone protection of structures in the midline of the chest makes the heart and large vessels vulnerable to trauma. The image of a protruding heart is uncomfortable for the patient and the parent. The expansion of the defect over time worsens the appearance and becomes more difficult to correct. If there is damage to the skin, infection may develop. By affecting the vessels, it negatively affects the heart function. For these reasons, treatment should definitely be done early. At an older age, surgical repair becomes more difficult, as the breast hardens and may require more complex repair methods. Autologous bone grafting, patches or titanium plaques can be used for reconstruction, especially if the defect is very extensive, or in adult patients.