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Postoperative physiotherapy32112First, the immediate postoperative phase of physiotherapy should be aimed at decreasing joint inflammation and pain and maintaining mandibular mobility to prevent the formation of abnormal adhesions.(7,9,34) The total number of exercises should be limited to 3 to 5 daily to avoid overexertion of the capsular tissue and muscles. The number of repetitions is kept high and the intensity is kept low during this phase because the main goals are to maintain mobility within a restricted range, prevent muscular inhibition, and decrease pain and inflammation without putting too much stress on the joint and muscles.(35,36) Frequent application of cold against the joint helps relieve pain by numbing the area and decreasing swelling and inflammation through vasoconstriction.(37) In the current mindset of fasttrack surgery, some might believe that opting for cryotherapy might prove more useful, but a recent RCT by Thienpont(38) concluded that there was no clinical advantage to the use of cryotherapy over conventional cold packs in patients who underwent a knee arthroplasty. In addition, sufficient pain medication should be prescribed as well because pain reduction will lead to more patient confidence and an improved ROM.(9)Second, ROM exercises should be incorporated, with limitation to condylar rotation. This is to prevent TMJ stretching, which could increase the inflammatory response or TMJ luxation in case of a TJR.(34) Movement also should be limited to within the pain-free zone. A possible exercise that can be performed is active vertical mandibular movement while the tongue maintains contact with the palate, because this limits the movements in such a way that only condylar rotation will occur.(7) These exercises are also known as ‘goldfish’ exercises. (Fig 2) The mandible can be passively opened and closed again using a finger, or also slowly actively opened and closed, while looking in a mirror to maintain good symmetric movement. The simple insertion of several tongue blades, or even the TheraBite system mouthpiece, without further activation, can also be used.Third, some mild joint mobilization can be performed by the physiotherapist, such as grade I and II joint distraction.(9) To prevent possible muscle overexertion, a ‘no chew diet’ is advised and detrimental parafunctions should obviously be avoided at all times.(9) Nikolas de Meurechy NW.indd 321 05-06-2024 10:15