Early Return to Competitive Sport Following a Surgically Managed Mandibular Fracture: A Multimodal Ultrasound-Guided...

Mandibular fractures in high-performance athletes challenge both structural stability and the rapid restoration of sport-specific function. Standard rehabilitation following open reduction and internal fixation (ORIF) often overlooks neuromuscular re-education, cervical-mandibular coordination, and the demands of elite athletic return.

A 23-year-old elite judoka from the Romanian National Team sustained a right mandibular angle fracture during training. ORIF was performed using titanium miniplates. At week 3 post-surgery, she presented with severe trismus (maximum interincisal opening [MIO] 15 mm) and significant pain (Visual Analog Scale [VAS] 8/10). A 12-week multimodal rehabilitation program was initiated, combining ultrasound-guided dry needling (masseter, temporalis, pterygoids, suprahyoids, sternocleidomastoid, and suboccipitals), temporomandibular joint (TMJ) manual therapy, and a structured digital home-based program (Healthy TMJ, 20 min daily). Early Transfer of Energy Capacitive and Resistive therapy induced swelling and was discontinued. By week 8, her MIO improved to 43 mm and VAS to 2-3, enabling return to competitive training and a Gold Medal at the Romanian National University Championship. At week 12, MIO reached 55 mm, VAS 1, and full functional recovery was achieved, culminating in a Bronze Medal at the FISU World University Championships.

This case demonstrates that a multimodal, ultrasound-guided rehabilitation approach can promote faster recovery, improve mandibular kinematics, and enable safe early return to elite competition following mandibular ORIF.