Septal Perforation Research Articles

Oral Rehabilitation for a Patient with Cocaine‐Induced Midline Destructive Lesions

Background. Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation causes significant centrofacial lesions, grouped under the name cocaine‐induced midline destructive lesion (CIMDL). These destructions are due to the conjunction of the vasoconstrictor, local prothrombogenic effects, and cytotoxic effects of cocaine. The ischemia produced by this substance is due to vasoconstriction that leads to nasal tissue necrosis and perforation of the nasal septum secondary to chondral necrosis. Case Presentation. A 36‐year‐old man, previously grappling with cocaine addiction, was hospitalized to undergo comprehensive clinical, microbiological, and radiological examinations because he was suffering from the emergence of crusts and ulceration in the nasal mucosa, accompanied by a palate perforation, a 39°C fever, and chills. Standard bacteriological culture was positive for coagulase‐negative staphylococci and Escherichia coli, while mycological culture was positive for Candida tropicalis. The CT scan images of the sinuses confirmed the presence of palatal perforation and total destruction of the nasal septum, cartilaginous portion, maxillary sinus medial wall, lower and middle turbinates, and middle meatus. Nasal endoscopy revealed an exposition of the bony wall and displayed the exposition of the occipital bone’s clivus. A diagnosis of CIMDL was confirmed. Antibiotic therapy was decided based on antibiogram results by the consulting microbiologist. Debridement of necrotic tissue was done by nasal endoscopy with local cleaning and was repetitive during the first week to maintain the best cleanliness possible. The patient was discharged with oro‐nasal hygiene instructions and referred for prosthetic rehabilation. As for the cocaine addiction, the patient was in follow‐up with a psychologist in a specialized centre. Conclusion. The care is multidisciplinary. Psychological help and assistance are essential to guide patients to become cocaine free and to avoid a relapse. Weaning is a prerequisite for surgery. Rehabilitation of speech and swallowing is necessary. Many local flaps or micro‐anastomoses are possible.

Nasal Septal Perforation Repair with a Unilateral Mucosal Flap and a Contralateral Skin Graft

Nasal Septal Perforation Repair with a Unilateral Mucosal Flap and a Contralateral Skin Graft

Characteristics and treatment of pediatric nasal foreign bodies with button batteries-A retrospective analysis of 176 cases.

Button battery nasal impactions pose serious risks due to complications and the need for prompt removal, yet research on interventions remains limited due to its rare occurrence. To delineate the clinical manifestations of nasal foreign bodies associated with button batteries and to explore treatment approaches focused on minimizing the reliance on general anesthesia and surgical interventions. This study focuses on 176 cases of children who received treatment for nasal cavity button battery impactions. It encompasses various factors including age, gender, battery location, impaction duration, methods of extraction, and associated complications. The incidence of nasal button battery cases among nasal foreign body instances was 1.16%, with a majority being males (60.23%) aged 1-5 years (98.29%). Utilizing a specially designed nasal foreign body hook and following established treatment protocols enabled the successful outpatient management of the majority of cases. Only 12 cases (6.82%) necessitated removal under general anesthesia due to management challenges in an outpatient setting. Furthermore, our findings indicated no linear correlation between the duration of battery retention and the risk of nasal septal perforation, which was observed in 31 cases (17.61%). Nasal foreign bodies caused by button batteries in children demand urgent attention due to their potentially grave outcomes. Our research is directed towards enhancing diagnostic and therapeutic strategies to bolster the success rates of outpatient removal, curtail the duration of foreign body retention, and diminish the reliance on general anesthesia.

Intra-Aortic Thrombosis Following Impella-Assisted Surgery for Ventricular Septal Perforation

Intra-Aortic Thrombosis Following Impella-Assisted Surgery for Ventricular Septal Perforation

Septal Perforation Repair with Temporalis Fascia and PDS Plate

Septal Perforation Repair with Temporalis Fascia and PDS Plate

Failure of Left Bundle Branch Pacing Owing to Iterative Septal Perforation: A Word of Caution for Thin Septum and Highly Dilated Cardiomyopathy

Failure of Left Bundle Branch Pacing Owing to Iterative Septal Perforation: A Word of Caution for Thin Septum and Highly Dilated Cardiomyopathy

Embolization of Perforated Coronary Artery with a Fragment of Balloon Catheter (Cut Balloon Technique)-Multicenter Study.

Iatrogenic distal coronary artery perforation can be a life-threatening complication. While there are different dedicated devices for the embolization of distal perforations, there are scarce data about the embolization using the fragmented balloon catheter, the so-called cut balloon technique (CBT). We included consecutive patients with distal coronary perforations treated with CBT in four cardiac centers between 2017 and 2023. Clinical, angiographic and procedural characteristics as well as in-hospital outcomes were recorded. Twenty-six patients (68% men, mean age: 71 ± 10.6 years) with 25 distal coronary perforations and one septal collateral perforation were included. Eleven patients (42%) had elective percutaneous coronary intervention, while fifteen patients (58%) were treated for acute coronary syndrome. The site of perforation was most frequently distributed in the left anterior descending artery (40%), followed by the circumflex artery (28%) and right coronary artery (24%). The diameter of balloons for CBT ranged from 1.5 to 4.0 mm, with most balloons (76%) being either 2.0 or 2.5 mm in diameter. Most balloons (88%) were previously used for lesion predilatation. The numbers of cut balloons needed to seal the perforation were 1, 2 and ≥3 in 48%, 20% and 32% of cases, respectively. The in-hospital prognosis was favorable, with cardiac tamponade requiring pericardiocentesis in only four (16%) patients. Neither emergency surgery nor cardiac death occurred. CBT is a safe, efficient and easy-to-implement technique for the embolization of coronary perforations. Most distal coronary perforations can be sealed with one or two fragments of cut balloons, obviating the need for additional devices.

The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series.

In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern wasnot associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. IV Laryngoscope, 134:2609-2616, 2024.

Evaluating the efficiency of endoscope-assisted septo-rhinoplasty via intranasal approach

Objective: To observe the functional and esthetic results of endoscope-assisted septo-rhinoplasty via intranasal approach. Methods: The clinical data of 12 patients with septal deviation and nasal deformity in the University of Hong Kong-Shenzhen Hospital from June 2021 to June 2022 were analyzed, including 8 males and 4 females, aging 28 to 58 years. All patients were operated under general anesthesia. The septal deviation was corrected by hemitransfixion incision, combined with intercartilaginous incision and other intranasal or extranasal incisions to perform osteotomy, hump resection and saddle nose correction. Patient satisfaction with postoperative functional and aesthetic improvements was assessed through Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and Visual Analogue Scale (VAS).SPSS 25 software was used for statistical analysis. Results: The correction of nasal septum deviation was satisfactory in all 12 patients. Nasal obstruction was relieved, with NOSE score and VAS score of nasal ventilation decreased [(21.67±10.30) vs (70.83±14.12), (1.83±1.03) vs (8.33±0.89), t value was 9.49 and 16.30, respectively, both P<0.05]. The nasal appearance of 10 patients with crooked nose deformity was improved, with ROE score and VAS score of nasal appearance increased [(21.30±2.31) vs (8.10±3.31), (8.90±0.99) vs (3.80±1.62), t value was -11.85 and -9.33, respectively, both P<0.05];The nasal vestibule morphology of 2 patients with abnormal nasal vestibule was improved. During the follow-up of 12 to 24 months, no postoperative complication such as nasal septum perforation, nasal cavity adhesion or nasal dorsal collapse occurred in all patients. Conclusion: Endoscope-assisted septo-rhinoplasty via intranasal approach can resolve both functional and esthetic problems at the same time, improving outcomes while reducing surgical trauma.

Coincidence of Systemic Lupus Erythematosus and ANCA-Associated Vasculitis: A Case Report with Perforation of Nasal Septum and Palate

Coincidence of Systemic Lupus Erythematosus and ANCA-Associated Vasculitis: A Case Report with Perforation of Nasal Septum and Palate

ЧАСТЫЕ КЛИНИЧЕСКИЕ ПРИЗНАКИ ЗАБОЛЕВАНИЙ НОСА И ОКОЛОНОСОВЫХ ПАЗУХ У БОЛЬНЫХ ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract. Introduction. Adequate advanced hemodialysis techniques reduce nosebleeds in patients with chronic renal failure. The most common otorhinolaryngological manifestations were nasal mucosa dryness, lower nasal concha pallor, and, to a lesser extent, crusts on both the nasal septum and the lower nasal concha. Aim of the study was to assess the frequency of various initial manifestations in hemodialysis patients with chronic renal failure. Materials and Methods. A crossover study was conducted in 2020-2022. It included 68 patients with chronic renal failure, receiving regular hemodialysis for 6 months and longer. Results and Discussion. Nasal mucosae were normal in 45.6% of patients, dry in 44.1%, and hyperemic in 10.3%. Inferior nasal conchae were pallor in 44.1% of patients, normal in 35.3%, and hypertrophic in 13.2%. Crusts were found in inferior nasal conchae in 7.4% of patients and in nasal septum in 14.7% of patients. Frequency of nosebleeds was lower in regularly hemodialyzed patients with chronic renal failure. Conclusions. Analysis of the studies conducted shows that the frequency of nosebleeds was reduced in regularly hemodialyzed patients with chronic renal failure. Ulceration and perforation of the nasal septum are the least frequent otorhinolaryngological signs. No cases of olfactory neuropathy were reported in our study.

Perforation of the Nasal Septum in a Patient with Takayasu’s Arteritis: A Case Report and Literature Review

Perforation of the Nasal Septum in a Patient with Takayasu’s Arteritis: A Case Report and Literature Review

The Use of Platelet-Rich Fibrin and Polypropylene Mesh in Repair of Nasal Septal Perforation.

In this study, we aimed to investigate the effectiveness of the use of polypropylene mesh and platelet-rich fibrin (PRF) in nasal septal perforation (NSP) repair. Prospective experimental study. Laboratory. Twenty-four adult male New Zealand rabbits were used in our study. In all subjects, a 10 × 10 mm perforation was created in the septum. The subjects were divided into 3 equal groups according to the different methods used in perforation closure. The bilateral mucosal flap was used in the control group, polypropylene mesh + bilateral mucosal flap in the mesh group, and polypropylene mesh + bilateral mucosal flap + PRF in the mesh + PRF group. NSP treatment success rate was found to be significantly higher in the mesh (4/6, 66.7%) and mesh + PRF (6/6, 100%) groups compared to the control group (0/6, 0%). Re-epithelialization score was higher in the mesh + PRF group and the control group compared to the mesh group. While the necrosis, neutrophil, and abscess scores were highest in the mesh group, they were similar to the control group in the mesh + PRF group. While polypropylene mesh significantly increases the success rate in NSP repair, it causes severe inflammatory responses. However, when polypropylene mesh is combined with PRF, it both increases the rate of perforation closure and significantly reduces the complications associated with the use of mesh.

Сравнительный анализ применения метода пластики перфорации перегородки носа лоскутом на сосудистой ножке

Введение. Закрытие перфораций перегородки носа в Республике Беларусь представлено различными методами хирургического лечения. В качестве пластических материалов применяются как собственная слизистая оболочка, так и различные трансплантаты. Цель. Сравнительный анализ разработанного метода пластики перфорации перегородки носа на сосудистой ножке с различными методами, применяемыми в Республике Беларусь. Материалы и методы. Материалом для исследования послужили данные 80 пациентов с хроническим ринитом, осложненным перфорацией перегородки носа. В основную (проспективную) группу вошло 49 пациентов, прооперированных разработанным методом пластики перфорации перегородки носа на сосудистой ножке, в контрольную (ретроспективную) группу вошел 31 пациент, прооперированный различными методами хирургического лечения. Результаты. Пациенты основной группы (n=49) имеют меньшее количество рецидивов перфорации перегородки носа по сравнению с пациентами контрольной (ретроспективной) группы (n=31) – 9 (18%) и 21 (68%) соответственно, p&lt;0,001. Сравнительный анализ основной и контрольной группы выявил статистически значимое улучшение средних показателей объема вдыхаемого воздуха в послеоперационном периоде (846,5 см3 и 620,8 см3 соответственно, p&lt;0,001); аэродинамики входящего потока вдыхаемого воздуха (50,1% и 34,8% соответственно, p&lt;0,001); восстановление симметричности вдыхаемого воздуха (0,1 и 0,4 соответственно, p&lt;0,001); показателей качества жизни по данным анкеты SNOT-22 (21,1 балла и 43,3 балла соответственно, p&lt;0,001). Из 49 прооперированных пациентов основной группы 29 (59%) переведены в группу нуждающихся только в терапевтическом лечении; из 31 пациента контрольной группы 9 (29%) переведены в терапевтическую группу, p=0,012. Выводы. Применение разработанного метода хирургического лечения – пластики дефекта перегородки носа на сосудистой ножке, включающего в себя элементы стандартных методов и новых приемов, позволяет уменьшить количество рецидивов, восстановить функциональность носовых структур и улучшить показатели качества жизни в послеоперационном периоде. Introduction. The nasal septum perforations closure repair in the Republic of Belarus is represented by various methods of surgical treatment. Both the own mucous membrane and various transplants are used as plastic materials. Purpose. A comparative analysis of the developed method of plastic surgery of perforation of the nasal septum on a vascular pedicle with various methods used in the Republic of Belarus. Materials and methods. The data of 80 patients with chronic rhinitis complicated by perforation of the nasal septum were the materials for the study. The main (prospective) group included 49 patients operated by the method of nasal septum perforation plastic surgery on the feeding artery; the control (retrospective) group included 31 patients operated by various methods of surgical treatment. Results. Patients of the main group (n=49) have fewer recurrences of nasal septal perforation compared to patients of the control (retrospective) group (n=31) (9 (18%) and 21 (68%), respectively, p&lt;0.001). Comparative analysis of the main (prospective) and control (retrospective) groups revealed a statistically significant improvement in the average volume of inhaled air in the postoperative period (846.5 cm3 and 620.8 cm3, respectively, p&lt;0.001); aerodynamics of the incoming flow of inhaled air (50.1% and 34.8%, respectively, p&lt;0.001); restoration of the symmetry of the inhaled air (0.1 and 0.4, respectively, p&lt;0.001); quality of life indicators according to the SNOT-22 questionnaire (21.1 points and 43.3 points, respectively, p&lt;0.001). Of the 49 operated patients of the main group, 29 (59%) were transferred to the group requiring only therapeutic treatment; out of 31 patients in the control group, 9 (29%) were transferred to the therapeutic group, p=0.012. Conclusions. The developed method of surgical treatment application by means of nasal septal defect plasty on the feeding artery, which includes elements of standard methods and new techniques, can reduce the number of relapses, restore the functionality of the nasal structures and improve the quality of life in the postoperative period.

A Novel Technique for Septal Perforation Repair: Fascia Lata Graft.

Nasal septal perforation (NSP) is an anatomical defect involving the mucosa, cartilage/bone of the nasal septum, most commonly caused by septoplasty. Spontaneous healing of a perforated septum is rare; instead, it tends to worsen over time. Several surgical approaches have been described for NSP repair. In this study, the authors present a novel technique using only fascia lata graft for repairing NSP of various sizes. The authors conducted a retrospective study, including 23 patients who underwent NSP repair between January 2020 and January 2022. Grafts were harvested, and the perforation was accessed through an open rhinoplasty approach, followed by insertion and suturing of the graft. The mean size of the septal perforations was 2.13 mm horizontally and 2.14 mm vertically. The mean follow-up period was 12 months. Complete closure of NSP was achieved in 21 out of 23 patients (91.30%). Among the cases, 17 were males (11.76%), and the age ranged from 20 to 43 years with a mean of 36.5. Eight cases (50%) were smokers. At 12 months postoperatively, 3 medium-sized NSPs were closed successfully, whereas 2 large NSPs did not achieve closure due to smoking. The fascia lata technique for NSP closure is a safe and reliable approach with a high success rate, which should be considered for patients with NSP.

Left bundle branch pacing versus left ventricular septal pacing as a primary procedural endpoint during left bundle branch area pacing: Evaluation of two different implant strategies.

Implant procedure features and clinical implications of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) have not been yet fully described. We sought to compare two different left bundle branch area pacing (LBBAP) implant strategies: the first one accepting LVSP as a procedural endpoint and the second one aiming at achieving LBBP in every patient in spite of evidence of previous LVSP criteria. LVSP was accepted as a procedural endpoint in 162 consecutive patients (LVSP strategy group). In a second phase, LBBP was attempted in every patient in spite of achieving previous LVSP criteria (n = 161, LBBP strategy group). Baseline patient characteristics, implant procedure, and follow-up data were compared. The final capture pattern was LBBP in 71.4% and LVSP in 24.2% in the LBBP strategy group compared to 42.7% and 50%, respectively, in the LVSP strategy group. One hundred and eighty-four patients (57%) had proven LBB capture criteria with a significantly shorter paced QRS duration than the 120 patients (37%) with LVSP criteria (115 ± 9 vs. 121 ± 13 ms, p < .001). Implant parameters were comparable between the two strategies but the LBBP strategy resulted in a higher rate of acute septal perforation (11.8% vs. 4.9%, p = .026) without any clinical sequelae. Patients with CRT indications significantly improved left ventricular ejection fraction (LVEF) during follow-up irrespective of the capture pattern (from 35 ± 11% to 45 ± 14% in proven LBBP, p = .024; and from 39 ± 13% to 47 ± 12% for LVSP, p = .003). The presence of structural heart disease and baseline LBBB independently predicted unsuccessful LBB capture. The LBBP strategy was associated with comparable implant parameters than the LVSP strategy but resulted in higher rates of septal perforation. Proven LBB capture and LVSP showed comparable effects on LVEF during follow-up.

Cadaveric and Computed Tomography Analysis of the Anterior Ethmoidal Artery Flap.

The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flap's axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width. Ten fresh latex-injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally. From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1-1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm. Based on the non-vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0-2.3 cm. NA Laryngoscope, 134:2100-2104, 2024.

Surgical repair of post myocardial infarction ventricular septal defect: a retrospective analysis of a single institution experience

IntroductionVentricular septal defect (VSD) is a mechanical complication of acute myocardial infarction (MI) with a very high mortality, despite advances in surgical and circulatory support. The tremendous hemodynamic disturbance and the severely fragile myocardium render surgical repair a great challenge. The optimal time of surgical repair with or without circulatory support is still controversial.ObjectiveThe aim of this study is to review our experience with early surgical repair of post-MI VSD in a single major cardiac institution in China.MethodsFrom January 2013 to October 2020, 9consecutive patients presented to our emergency department with a diagnosis of post-MI VSD. Among them, 8 were male, and the mean age was 58 ± 7years. The mean VSD size was 22.5 ± 5.7 mm. In all patients, an intra-aortic balloon pump (IABP)was inserted immediately after admission to cardiac surgery service. All patients were operated at a mean of 3.3 ± 2.9 days, and 4 within 24 h of the rupture (range 1 to 9 days post-VSD). In 5 cases, the VSD was located superiorly, and 4 cases in the posterior septum.ResultsThe overall 30-day mortality was 11% (1/9). Coronary angiography was performed in all nine patients, four with single vessel disease had coronary stents implanted, and the other five received concomitant coronary artery bypass grafting during VSD repair surgery. There was no death in all 5 patients with anterior septal perforation. One patient with posterior septal perforation died in the operating room due to bleeding from the ventriculotomy site. Three survived patients were diagnosed with a small residual defect and mild left to right shunt post-repair. However, no further intervention was required, and patients remained asymptomatic (Killip II in 1 and III in 2).ConclusionIn our experience, immediate insertion of IABP and hemodynamic stabilization with early surgical intervention of VSD repair and concomitant coronary revascularization provided an 89% survival rate.

Abstract 15370: Excellent Short-Term Outcomes Achieved With Minimally Invasive Right Infra-Axillary Incision and Transaortic Modified Morrow Procedure

Introduction: The Morrow procedure serves as the gold standard surgical intervention for hypertrophic obstructive cardiomyopathy. However, the conventional approach has its limitations. Minimally invasive approaches have been proposed, but exposure, mitral valve disruption, and cosmetic outcomes remain challenging. This study presents a single-port mini-incision thoracotomy through the right infra-axillary region with no surgical scar on the anterior chest wall. The procedure has achieved excellent short-term surgical outcomes. Methods: A comprehensive retrospective analysis was conducted, examining clinical data from 110 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure between August 2021 and March 2023. The patient cohort comprised 62 males and 48 females, ranging in age from 15 to 71 years. Echocardiography was employed to confirm moderate mitral regurgitation in 50 patients and severe mitral regurgitation in 24 patients. Preoperatively, 102 patients exhibited systolic anterior motion (SAM). All 110 patients underwent the transaortic modified Morrow procedure, utilizing a 4-cm incision in the right infra-axillary region, with femorofemoral cardiopulmonary bypass. Results: There was no conversion to full sternotomy. Postoperative gradients across the left ventricular outflow tract were (7.7±4.3) mmHg. Impressively, extubation was successfully performed on the operating table for 102 patients, who experienced a median postoperative hospital stay of (9.2±3.0) days. Drainage volume in the first 24 hours was (160.4±56.0) ml. Postoperative septal thickness was (11.0±1.8) mm, and no iatrogenic ventricular septal perforation or residual SAM was observed. Follow-up at 3~22 months showed no major complications. Conclusions: The single-port mini-incision thoracotomy through the right infra-axillary region is a safe and effective approach for the Morrow procedure, with excellent short-term surgical outcomes and no visible surgical scar. The procedure offers several advantages, including minimal invasiveness, reduced trauma, faster recovery, and improved cosmetic outcomes. The technique is feasible and reproducible and may be a promising alternative to traditional approaches.

Laurencia mediterranea sp. nov. (Ceramiales, Rhodophyta) from the central Mediterranean Sea

Abstract The identification of macroalgal species within the Laurencia complex is challenging, due to the presence of inconspicuous morphological characters, extensive variation in these traits and a diverse biogeography. Moreover, for a number of these species, no DNA sequence data are available in online databases. For this study, five algal specimens, tentatively assigned to Laurencia, were collected from Malta in the central Mediterranean Sea and studied using an integrative systematics approach. An analysis of the data resulted in the description of a new species, Laurencia mediterranea using combined morphological and molecular criteria, including COI-5P and rbcL. Morphologically L. mediterranea sp. nov. was distinct from other Laurencia spp. in the type of holdfast, the colour and shape of the thallus, the presence of secondary pit connections, lenticular thickenings and ‘corps en cerise’. Moreover, a new genetic species cluster indicated a separate taxon at the species level. Our study demonstrates that genetic sequences having clear links to sample metadata and digital herbaria are indispensable for macroalgal biodiversity research. This approach could offer a solution for algal taxonomy in cases where biogeography is important and limited sequence data exist in online DNA libraries.