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Postoperative physiotherapy32512Fig. 5: Guidance exercise: maximal mouth opening with index finger. For maximal mouth opening, the index finger rests on the midline to indicate the center of the lower jaw. During opening and closing, the patient should attempt to keep the index finger moving in a straight line while standing in front of a mirror.Depending on the type and focus of the exercise, the number of repetitions can be similar to the second phase or be decreased while increasing the total load, with the focus further shifting toward muscular strength.(35,43)Isometric contractions of the jaw in a neutral position can be used to gain better stability. This can be accomplished by attempting to open the mouth from an occlusal position while performing upward manual pressure against the mandible, by preventing movement of the lower jaw, or by applying upward/lateral manual pressure against the mandible, while the lower jaw maintains its position through muscle activity.(Fig. 6) Further strengthening and loading of the muscles through active and passive exercises and increasing muscle endurance are central in this phase. Continued previous exercises and forced opening exercises and strengthening exercises, such as active resistance exercises, can be Nikolas de Meurechy NW.indd 325 05-06-2024 10:15