Congenital Midline Cervical Cleft: Can It Be Treated in Newborn?
A one-day-old boy was admitted in our neonatal unit with a midline cervical abnormality. The neonate was born by caesarean section after an uncomplicated pregnancy and weighed 3200 gram having a normal Apgar score. There was no family history of congenital defects and his parents were also in good health. On examination there was a midline vertical mucosal surface in the anterior neck extending from below the mental process of mandible to suprasternal area with no skin covering. The defect was 3 cm in vertical length and 0.5 cm in width. A nipple like projection was observed in the upper part of the defect and there was a sinus in the lower part of the defect above the manubrium. The sinus was examined by a small lacrimal probe and a narrow tract coursing toward the suprasternal notch was observed.\nA fistulogram was not done, but ultrasound scan of the neck showed no evidence of any cervical abnormality (). Auscultation revealed heart murmur caused by small ASD shown in echocardiogram. The chest X-ray was normal.\nThe infant was operated on the fifth day of life by the preference of the parents. A vertical elliptical incision was done around the cervical cleft and the mucosal defect, and then all the pathologic tissues with the underlying fibrotic cord were completely removed. The fibrous cord attached to the manubrium was removed. The skin defect was closed by 2 serial Z-plasties. The 4 resultant flaps were sutured first by vicryl 5-0 for dermal suture and by nylon 6-0 for skin closure ().\nPathologic results showed that the skin cleft was covered by a thin epidermis with irregular papillomatosis, located on a fibrotic dermis devoid of skin appendages. A small skin projection was seen consisting of mature fibro fatty tissue, haphazardly arranged striated muscle bundles, and a normal epidermis as covering.\nAlso a sinus tract lined by parakeratotic stratified squamous epithelium as well as respiratory epithelium was observed. The sinus tract was surrounded by a mildly inflamed fibro vascular stroma enclosing a few striated muscle bundles and mucous secreting glands.\nPost operative course was uneventful and there was no wound infection. In a follow-up examination, 1 and 6 months after operation, there was excellent wound healing of the Z-plasty and no wound contracture in the neck could be seen ().