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Postoperative physiotherapy31512as measured by a Mann-Whitney U test, a more significant decrease in pain was seen in the treatment group after two months at rest (P = .02) and during activities (P = .004).(14)Oh et al(7) surgically treated 44 patients, of which 22 received an elaborate postoperative physiotherapy schedule, whereas the control group did not receive any physiotherapy after discharge from the hospital. As measured by an independent t test, they concluded that both groups showed a similar improvement in the VAS pain score 6 weeks after surgery (P = .80). They attributed this to the fact that the surgery rather than the physiotherapy brought initial pain relief. However, 7 months after surgery, the treatment group scored significantly better (P = .05), showing the importance of physiotherapy over the long-term.(7) Leandro et al(15) conducted a 10-year follow-up study of patients who underwent TMJ TJR using a Biomet total TMJ replacement system (Zimmer Biomet, Warsaw, IN, USA). 300 patients were treated after being diagnosed with severe joint or articular changes or condylar resorption. Patients underwent rigorous physical therapy from 48 hours after surgery for a minimum of 12 weeks. During follow-up, it became apparent that those patients (n = 13) who showed a final MMO of less than 25 mm had not properly conducted their physiotherapy. Also, impaired function of speech was seen in those patients who did not follow their physiotherapy schedule. Despite not having been set up as a comparative trial, it was clear that not performing postoperative physiotherapy had an obvious negative effect on the restoration of mandibular function.Robiony(16) treated 5 patients with the Biomet/Lorenz TJR system for TMJ ankylosis. Although patients quickly showed a significant decrease in their VAS score for pain, despite “vigorous physiotherapy”, the MMO remained less than 30 mm after 4 months. In an attempt to improve the MMO, 5 injections of botulin toxin A (BTX-A) were given in the masseter muscle. These injections allowed for muscle relaxation and, with an additional physiotherapy schedule with manual finger stretching, TheraBite system exercises, active hinge opening, and lateral excursions, elongation of the muscle fibers occurred, allowing for a significant improvement in MMO. Nikolas de Meurechy NW.indd 315 05-06-2024 10:15