title: Physiotherapy Maneuver Is Critical to Recover Mouth Opening After Pediatric Trauma.
abstract: OBJECTIVE
  A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma in pediatric patients and develops in 4 to 26.2% of cases. The purpose of the present study was to quantitatively investigate the influence of patient demographic data, fracture characteristics, and regular vigorous physiotherapy, with either voluntary or forcible MO exercises, on the recovery of a post-traumatic restricted MO in pediatric patients.
  
  
  METHODS
  A prospective cohort study was performed of pediatric patients with maxillofacial injuries who had been referred to Al-Zahraa and El-Fayoum Hospitals from 2013 to 2015. The predictive variables were patient demographic data, fracture characteristics, and regular vigorous physiotherapy. The patients were treated with a closed technique. The MO measurements were the clinical outcome variables and were recorded at the first week and then monthly for 12 months. Regular vigorous physiotherapy was performed until the patients had returned to their preoperative MO. The data were tabulated and statistically analyzed.
  
  
  RESULTS
  Eighty-six patients were enrolled in the present study. Males predominated. Falls were the most common cause of fracture. Condylar fractures had the greatest incidence. A restricted MO occurred in 81 patients. The results showed no interaction between MO recovery and age, gender, etiology, or fracture site. After physiotherapy, the patients had returned to their preoperative MO at the fourth month, with the measurements fixed at normal values at the sixth month. The recovery rate was nonlinear, with faster improvement in the months closest to the injury.
  
  
  CONCLUSIONS
  Physiotherapy is more critical in the recovery of the MO and prevention of bony ankylosis than patient data or fracture characteristics in pediatric trauma. We highly advocate the performance of voluntary mouth exercises, even in the absence of fracture. Forcible MO exercises are mandatory to recover a restricted MO. These exercises should be performed under close supervision of the patient's surgeon with the parents motivated to cooperate for at least 6 months.
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al Azhar University, Nasr City, Cairo, Egypt. Electronic address: ghadaamin@ymail.com.
authors: Ghada Amin
authors: GA
authors: Khalifa
authors: Associate Professor, Department of Oral Medicine, Periodontology, Diagnosis, and Radiology, Faculty of Dental Medicine for Girls, Al Azhar University, Nasr City, Cairo, Egypt.
authors: Naglaa Shawki
authors: NS
authors: El-Kilani
authors: Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al Azhar University, Nasr City, Cairo, Egypt.
authors: Hanan Mohamed
authors: HM
authors: Shokier
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013704:Temporomandibular Joint / Q000503:physiopathology*; D016896:Treatment Outcome