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Chapter 12318These findings were also supported by several other articles, such as a study conducted by Singh et al,(29) who treated 10 patients with an ankylotic TMJ by placement of a sternoclavicular graft with buccal fat pad lining, after which an intense physiotherapeutic program was set up. Physiotherapy started within 1 day after surgery with both passive and active exercises, which increased over time. Although follow-up was limited to 6 months, a marked improvement in MIO, laterotrusion, and protrusion were seen. Furthermore, all patients claimed to be pain-free after 6 months. They found that the improvements in mobility were greater compared with similar studies and attributed this to the use of the buccal fat pad (instead of temporalis muscle) and the aggressive physiotherapy. They also stressed that neglecting postoperative physiotherapy can negate a potentially successful reconstruction. In a prospective trial by Lo et al(30) 5 patients with an ankylotic TMJ (unilateral or bilateral), had a surgical release performed. Unlike most studies, Lo et al(30) allowed their patients to halt their postoperative physiotherapy with a TheraBite-like exerciser as soon as they deemed it was no longer necessary. Moreover, the physiotherapeutic schedule was very limited compared with the studies included in this systematic review. In allowing the patients to determine when to stop, the mean treatment time was only 40 days and the minimum duration was as short as 14 days. Lo et al(30) found that although results at the end of the physiotherapy treatment period had significantly improved to a mean MMO of 29.6 ± 4 mm, a notable relapse occurred in the posttreatment period, with the mean MMO decreasing to 23.8 ± 8.3 mm. In comparison, other patients who underwent orthognathic or trauma surgery did not show a similar relapse. In addition, they concluded that, for treatment of an ankylotic TMJ, more rigorous, prolonged, and frequent physiotherapy is needed.Physiotherapeutic PhasesWhen researching different physiotherapeutic techniques and trying to provide a potential postoperative treatment plan (included in Table 8), it is important to understand the different postoperative phases the joint goes through and why certain techniques are more suited for a phase than others. As stated by Dijkstra et al(9), even the insertion of fine arthroscopic instruments into the TMJ will lead to the development of Nikolas de Meurechy NW.indd 318 05-06-2024 10:15