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Introduction: The aim of the study was to highlight the effects of the reaction forces that produce stress on the hard structures of the jaw during mandibular lateral movement by using the finite element method. For a good understanding of the distribution and intensity of these forces during lateral movement, two clinical models from which the virtual models were obtained were studied. The first model was with advanced wear and end to end occlusion and the other was with bruxism and Angle Class II 2 with deep overbite. These two models were compared with an ideal virtual masticatory system. Materials and Methods: The study used a virtual masticatory system model obtained in a previous study which was considered to be ideal. This model was used to obtain the two virtual models based on the dental casts of the two real clinical cases. Results: The maximum load measured by stress, displacement and strain was recorded in the deep overbite patient model, followed by the end to end occlusion patient model and then the ideal model. Loading, represented by stress, displacement, and strain, was localized on compact bone tissue of the jaw: canine eminence, sutures of the viscerocranium, and even in the palatine bone. In the mandible, maximum load localization represented by stress, displacement and strain was on the compact bone in the premolar region and mandibular symphysis. Conclusions: The study demonstrated the presence of stress generated by the reaction forces and its distribution to the jaw bone during mandibular movement. The highest stress value was recorded in the case of deep overbite patient, suggesting that the mandible has the greatest deformation in lateral movement in the occlusion.

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable.

Introduction: Gallbladder hydrops is an increase in the volume of the gallbladder without any inflammatory sign, bacterial infection or the presence of any abnormalities of the biliary ducts or of the gallbladder. Case presentation: A 52-year-old man presented at the Department of Internal Medicine complaining of moderate intensity pain in the right upper quadrant, low fever, fatigue, general weakness, symptoms stemming from an excessive intake of food (a meal abundant in animal proteins, fats, and alcohol) which appeared following a 6-week period of food restriction. On examination, the patient presented a globular abdomen, sensitive to deep palpation in the right upper quadrant, the liver and spleen being impalpable. Blood tests performed on admission showed liver-specific pathological changes. Abdominal ultrasound revealed hepatomegaly with homogeneous echostructure, slightly increased echogenicity with rear attenuation, with no focal images, intrahepatic biliary duct dilatation, or dilated suprahepatic veins. The gallbladder looked dropsical, with slender walls, with images of hyperechoic infundibular calculi with a posterior shadow cone, the largest having 14 mm. The portal vein and bile duct were normal in appearance. Conclusions: Gallbladder hydrops is a disorder commonly seen in children. Its occurrence in adults is uncommon, moreover since it occurs simultaneously with an episode of acute toxic hepatitis. Surgery for this patient was possible only after normalization of liver function tests, on admission there being no subjective complaints of marked intensity that required immediate surgery.