From Conventional Septoplasty to Patient-Specific Cartilage Reshaping: A Systematic Review of Laser-Mediated and...

Background: Energy-based techniques for septal cartilage reshaping, including laser-mediated cartilage reshaping (LCR) and electromechanical reshaping (EMR), have been investigated for more than three decades as minimally invasive alternatives to conventional septoplasty. Despite encouraging preclinical findings, their clinical translation remains limited. Their relevance to personalized medicine lies in the possibility of tailoring septal correction to individual anatomy, cartilage-dominant deformity patterns, and patient-specific functional needs. Objective: To systematically review the experimental and clinical evidence on LCR and EMR for nasal septal cartilage reshaping and to evaluate their potential role within a personalized, function-oriented treatment framework. Methods: A PRISMA 2020-compliant systematic search of PubMed, Scopus, and Web of Science was performed for English-language studies published up to June 2025. Original experimental or clinical studies investigating LCR or EMR applied to human or animal septal cartilage were included. Because of heterogeneity in models, dosimetry, and outcome reporting, a qualitative synthesis was undertaken. A design-specific critical appraisal was also performed. Results: Eighteen studies met the inclusion criteria (LCR: n = 9; EMR: n = 9). LCR consistently induced shape change within a narrow thermo-mechanical relaxation range (55-75 °C), but showed dose-dependent risks of chondrocyte injury and matrix degeneration, with limited applicability to complex osseocartilaginous deviations. Only three human LCR studies were identified, all short-term and limited to mild cartilaginous deformities. EMR produced reproducible, charge-dependent reshaping at near-physiological temperatures, but human studies were lacking. Neither technique addressed bony deviations, and none assessed functional benefit using computational fluid dynamics. Conclusions: Both techniques remain predominantly preclinical and may currently serve only as adjunctive options for selected anterior, cartilage-dominant deformities. Future translation will require validated dosimetry, long-term human data, and patient-specific functional assessment.