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Aims & objectives To analyze the soft tissue response in patients treated by combined anterior segmental bimaxillary procedures. Methods A Prospective, observational and analytical study was carried out for a period of 2 years involving 37 patients with predefined inclusion and exclusion criteria; lateral cephalograms were taken by the same operator on the standardized unit immediately before and 6 months after surgery; hard and soft tissue landmarks were measured in millimeters to both horizontal and vertical reference lines; any differences in distances were recorded as a surgical change; appropriate statistical test was carried; level of significance was p \ 0.05. Results All patients underwent anterior maxillary osteotomy with 34 anterior mandibular osteotomies, 2 advancement genioplasties and 1 reduction genioplasty. Analysis showed significant angular, horizontal and vertical change. The significant differences in skeletal variables were observed in N-Pg distance, overjet, overbite, U1-NF angle, L1-Mp angle and soft tissue variables like labiomental angle, upper-lower lip protrusion, upper-lower lip length and lower incisor to labrale inferius distance. Nasolabial angle, interlabial gap and upper incisor exposure were extremely significant. Conclusion Soft tissue response to surgery is perhaps more predictable after 6 months, so this may be a treatment modality of choice in adult bimaxillary/dentoalveolar protrusion patients who need instant esthetic facial results.

Alkaptonuria is a rare autosomal recessive disorder due to a lack of the enzyme homogentisate dioxygenase, leading to ochronosis, a process of accumulation of a melanin-like polymer of homogentisic acid in cartilage and other collagenous structures. Patients develop severe osteoarthropathy that resembles osteoarthritis. Although the diagnosis of alkaptonuria is not particularly challenging in view of the blue-black discolouration of visible connective tissue and the presence of homogentisic acid in urine, the natural history of alkaptonuria remains poorly understood. Patients would benefit immensely from an objective assessment of their disease status and from a clearer understanding of the pathophysiology and associated physical changes. Isotope bone scans, which are commonly used to identify the extent of involvement of bones in cancerous processes, have also been increasingly used for characterizing the extent of arthropathy in conditions such as osteoarthritis and rheumatoid arthritis. Semiquantitative scores based on the extent of involvement of joints have been used to describe the involvement of large joints in the context of symptomatic treatment for osteoarthritis. A similar semiquantitative isotope bone scan score depending on the involvement of the number of large joints in patients with alkaptonuria can be formulated and validated in a suitable cohort of patients. Bone densitometry measurement using dual-energy X-ray absorptiometry scanning is an internationally accepted tool to assess the risk and extent of osteoporosis, and is increasingly used to assess the additional fracture risk in patients with arthropathy. We believe that, currently, nuclear medicine techniques can provide useful information, which can be incorporated into disease severity scores for alkaptonuria. Once the biological basis for alkaptonuria is better understood, it is feasible that nuclear medicine techniques of even greater sensitivity and specificity can be developed, thereby taking advantage of the vast advances in the fields of radiochemistry, radiopharmacy, positron emission tomography-computed tomography and positron emission tomography-magnetic resonance imaging scanning.

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