Mandibular fractures account for up to 24% of maxillofacial injuries in contact sports and may result in chronic dysfunction if rehabilitation is inadequate ^[1,2]. Conventional post-open reduction and internal fixation (ORIF) care prioritizes fixation and bone healing but often neglects neuromuscular and sport-specific performance. Dry needling and manual therapy have shown significant benefits in temporomandibular dysfunction ^[3,4,5], but their application in post-surgical rehabilitation remains limited. In addition, cervical region rehabilitation is essential due to the biomechanical coupling between the upper cervical spine (C0–C3) and the mandibular complex – particularly relevant for combat athletes requiring cervical-jaw coordination and proprioceptive control ^[6,7]. This report describes a successful, multimodal physiotherapy protocol that integrated ultrasound-guided dry needling, temporomandibular joint (TMJ) manual therapy, and a digital exercise platform, facilitating accelerated, medal-winning return to sport following mandibular fracture surgery.

A 23-year-old elite judoka sustained a displaced right mandibular angle fracture involving tooth 4.8 during sparring. Computed tomography reconstruction confirmed displacement (Fig. 1), and open reduction with double titanium miniplates was performed (Fig. 1).

Figure 1: Hospital Surgery Report

Post-surgical management: The patient received Augmentin 1000 mg (2 × /day for 5 days) and Ketonal Duo 150 mg as needed for pain. She required analgesia for the first 5 days post-operation and once more during reintroduction to training. At week 3 post-surgery: Maximum interincisal opening: 15 mm, Visual Analog Scale pain: 8/10, Diet: Liquid only, unable to train. An external Transfer of Energy Capacitive and Resistive session induced facial swelling (Fig. 2,3) and was discontinued. Subsequently, a comprehensive physiotherapy program began at week 3.

Figure 2: Ultrasound Guided Dry Needling.

Figure 3: FISU World University Championships.

The integration of ultrasound-guided dry needling, TMJ manual therapy, and digital home exercises allowed rapid pain relief, restoration of mandibular mobility, and early return to elite competition. Traditional post-ORIF recovery often requires 12–20 weeks before athletes regain full performance ^[1,2]. The approach used here accelerated recovery by approximately 50%, consistent with evidence supporting neuromuscular retraining and cervical-mandibular coupling ^{[3,4,5,6,7,8,9,10]}. High adherence, facilitated by digital tracking, likely contributed to success. To our knowledge, this is the first report of an elite athlete achieving a podium finish within 3 months after mandibular fracture surgery. Further research should compare multimodal physiotherapy with standard protocols to validate these findings.

A multimodal physiotherapy protocol incorporating ultrasound-guided dry needling, TMJ manual therapy, and digital rehabilitation was associated with the earliest documented return to elite-level competition after mandibular ORIF. This integrative approach supports redefining post-surgical rehabilitation timelines in athletes recovering from maxillofacial trauma.

Targeted physiotherapy focusing on masticatory and cervical muscle re-education, guided by ultrasound and supported by digital adherence tools, enables early, safe return-to-sport following mandibular fracture surgery.