What is the Gluteal Cleft?
The gluteal cleft (also called the gluteal fold, intergluteal cleft, or natal cleft) is the vertical groove or depression that runs between the two buttocks, extending from the sacrum superiorly down to the perineum inferiorly. 1
Anatomical Definition and Boundaries
The gluteal cleft represents a key anatomical landmark with specific boundaries:
- Superior border: Begins at the sacral region 1
- Inferior border: Extends to the anterior perineum and inferior gluteal fold 1
- Lateral borders: Bounded by the buttock masses on either side 1
The tops of the two "forks" of the gluteal cleft serve as an important clinical reference line for distinguishing normal from pathological findings, particularly when evaluating sacral dimples in infants. 1, 2
Clinical Significance
Pediatric Assessment
The gluteal cleft serves as a critical anatomical reference point for evaluating newborns and infants:
- Dimple location assessment: An imaginary line drawn between the tops of the two forks of the gluteal cleft distinguishes benign coccygeal dimples (at or below this line) from pathological lumbosacral dermal sinus tracts (above this line on the flat part of the sacrum). 1, 2
- Coccygeal dimples: Normal dimples located within the gluteal cleft, typically within a centimeter of the coccyx, are present in approximately 4% of the population and require no further workup. 1
- Pathological findings: Dimples above the gluteal cleft line, especially when associated with cutaneous markers (hair tufts, hemangiomas, subcutaneous masses, or deviated gluteal cleft), require immediate referral to pediatric neurosurgery. 1, 2, 3
Pathological Conditions
The gluteal cleft region is susceptible to various pathologies:
- Pilonidal disease: The most common pathology affecting the gluteal cleft, though other conditions must be differentiated including folliculitis, hidradenitis suppurativa, and moisture-associated skin damage. 4, 5
- Pressure ulcers: Can develop in the sacral and gluteal cleft region, particularly in immobilized patients. 5, 6
- Inflammatory conditions: Including perianal manifestations of Crohn's disease and hidradenitis suppurativa, which may involve the gluteal cleft region. 4
Surgical Relevance
The gluteal cleft anatomy is important for reconstructive procedures:
- Gluteal fold flaps: Used for perineal reconstruction following ablative procedures for gynecological, urological, and colorectal malignancies. 7
- Anatomical variations: The superficial fascial system shows regional variation patterns in the gluteal fold region, with implications for liposuction and contouring procedures. 8
Common Clinical Pitfalls
Avoid relying on the visibility of a dimple's base to determine pathology—this teaching is incorrect; location relative to the gluteal cleft line is the critical determining factor. 1, 2