{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:13:36Z","timestamp":1789604016439,"version":"build-2803163510"},"reference-count":62,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T00:00:00Z","timestamp":1637280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. A boy aged seven years and five months was diagnosed with stage three group III embryonal parameningeal RMS with intracranial extension. He received chemotherapy for 23 weeks in combination with localized radiotherapy during the inductive phase of nine weeks (a total tumor dose of 5040 cGy). Three months later, he was referred to the department of pediatric dentistry for radiation-induced caries, the treatment of which was later terminated because of severe trismus and radiation-induced oropharyngeal mucositis. Three years later, the patient returned for the fitting of a prosthesis because of mastication problems. The dental treatments performed included: extraction, banding, composite resin restorations, root canal fillings, and stainless steel crown fabrication. An interim denture was fitted due to the poor retention of the fixed prosthesis. As the patient grew older, they developed facial asymmetry as a result of the prominent atrophy of their right cheek. By the age of 32, they had lost multiple teeth and exhibited severe facial deformity. Therefore, it is essential not only to involve a multidisciplinary medical team before, during, and after cancer therapy, but also to initiate long-term follow-ups given the potential effects of late sequelae after chemoradiation in multiple developmental areas.<\/jats:p>","DOI":"10.3390\/ijerph182212158","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T08:29:17Z","timestamp":1637310557000},"page":"12158","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Long-Term Follow-Up of Dental and Craniofacial Disturbances after Cancer Therapy in a Pediatric Rhabdomyosarcoma Patient: Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-1071","authenticated-orcid":false,"given":"Pei-Ching","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Pediatric Dentistry, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9597-0613","authenticated-orcid":false,"given":"Shiao-Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Lin-Kou Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/(SICI)1096-911X(199807)31:1<8::AID-MPO2>3.0.CO;2-H","article-title":"Teratomas in infancy and childhood","volume":"31","author":"Calaminus","year":"1998","journal-title":"Med. Pediatric Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1590\/S1808-86942010000400020","article-title":"Rhabdomyosarcoma of the head and neck: 24 cases and literature review","volume":"76","author":"Moretti","year":"2010","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3389\/fpubh.2013.00017","article-title":"Early life factors and risk of childhood rhabdomyosarcoma","volume":"1","author":"Shrestha","year":"2013","journal-title":"Front. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/00001622-200007000-00010","article-title":"Rhabdomyosarcoma and soft tissue sarcoma in childhood","volume":"12","author":"Womer","year":"2000","journal-title":"Curr. Opin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/S1368-8375(01)00105-1","article-title":"Rhabdomyosarcoma of the head and neck in children","volume":"38","author":"Hicks","year":"2002","journal-title":"Oral Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1002\/cncr.28748","article-title":"Declining childhood and adolescent cancer mortality","volume":"120","author":"Smith","year":"2014","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/pbc.24118","article-title":"Rhabdomyosarcoma: Review of the Children\u2019s Oncology Group (COG) soft-tissue Sarcoma committee experience and rationale for current COG studies","volume":"59","author":"Malempati","year":"2012","journal-title":"Pediatric Blood Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/154411130301400305","article-title":"Oral sequelae of head and neck radiotherapy","volume":"14","author":"Vissink","year":"2003","journal-title":"Crit. Rev. Oral Biol. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1200\/JCO.2011.40.3287","article-title":"Randomized comparison of intensified six-drug versus standard three-drug chemotherapy for high-risk nonmetastatic rhabdomyosarcoma and other chemotherapy-sensitive childhood soft tissue sarcomas: Long-term results from the International Society of Pediatric Oncology MMT95 study","volume":"30","author":"Oberlin","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s00520-008-0567-1","article-title":"Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children","volume":"17","author":"Veerkamp","year":"2009","journal-title":"Supportive Care Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.14219\/jada.archive.1993.0074","article-title":"Local radiation and systemic chemotherapy: Preventing and managing the oral complications","volume":"124","author":"Carl","year":"1993","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/cncr.20762","article-title":"Agenesis and microdontia of permanent teeth as late adverse effects after stem cell transplantation in young children","volume":"103","author":"Alaluusua","year":"2005","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S1079-2104(96)80145-4","article-title":"Caries-related salivary microorganisms and salivary flow rate in bone marrow recipients","volume":"81","author":"Dens","year":"1996","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1365-263X.2009.00999.x","article-title":"The oral health needs of children after treatment for a solid tumour or lymphoma","volume":"20","author":"Hutton","year":"2010","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1080\/019262301316905246","article-title":"Morphological classification of dental lesions induced by various antitumor drugs in mice","volume":"29","author":"Satoh","year":"2001","journal-title":"Toxicol. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1002\/pbc.24842","article-title":"A systematic review of dental late effects in survivors of childhood cancer","volume":"61","author":"Gawade","year":"2014","journal-title":"Pediatric Blood Cancer"},{"key":"ref_17","first-page":"217","article-title":"Disturbances in the oral cavity in pediatric long-term survivors after different forms of antineoplastic therapy","volume":"16","year":"1994","journal-title":"Pediatric Dent."},{"key":"ref_18","first-page":"58","article-title":"Wheeler\u2019s Dental Anatomy, Physiology, and Occlusion","volume":"69","author":"Allen","year":"2003","journal-title":"N. Y. State Dent. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/00220345650440013501","article-title":"The Effect of Fractional Radiation on Dentinogenesis in the Rat","volume":"44","author":"Collett","year":"1965","journal-title":"J. Dent. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/BF02561410","article-title":"The dentino-enamel junction: A structural and microanalytical study of early mineralization","volume":"45","author":"Arsenault","year":"1989","journal-title":"Calcif. Tissue Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/S0929-693X(00)90312-9","article-title":"Dental anomalies following anticancer chemotherapy","volume":"8","author":"Nawrocki","year":"2001","journal-title":"Arch Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/ejo\/19.2.151","article-title":"Long-term dental development in children after treatment for malignant disease","volume":"19","author":"Forsberg","year":"1997","journal-title":"Eur. J. Orthod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1980","DOI":"10.1002\/1097-0142(19810415)47:8<1980::AID-CNCR2820470813>3.0.CO;2-Y","article-title":"Osteonecrosis in patients irradiated for head and neck carcinoma","volume":"47","author":"Morrish","year":"1981","journal-title":"Cancer"},{"key":"ref_24","unstructured":"Yagiela, J.A., Neidle, E.A., and Dowd, F.J. (1998). Oral complications of cancer therapy. Pharmacology and Therapeutics for Dentistry, Mosby-Year Book Inc.. [4th ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/S1079-2104(99)70026-0","article-title":"Oral mucositis in myelosuppressive cancer therapy","volume":"88","author":"Epstein","year":"1999","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1053\/jinf.2002.1084","article-title":"Gingivitis and toothbrushes: Potential roles in viridans streptococcal bacteraemia","volume":"46","author":"Kennedy","year":"2003","journal-title":"J. Infect."},{"key":"ref_27","first-page":"53","article-title":"Dental care of the pediatric cancer patient","volume":"26","year":"2004","journal-title":"Pediatric Dent."},{"key":"ref_28","unstructured":"(2018). Guideline on dental management of pediatric patients receiving chemotherapy, hematopoietic cell transplantation, and\/or radiation. Pediatric Dent., 40, 392\u2013400."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1754-4505.1992.tb00423.x","article-title":"The lack of efficacy of a foam brush in maintaining gingival health: A controlled study","volume":"12","author":"Addems","year":"1992","journal-title":"Spec. Care Dentist."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/00002820-199510000-00009","article-title":"A combined analysis of a toothbrush, foam brush, and a chlorhexidine-soaked foam brush in maintaining oral hygiene","volume":"18","author":"Ransier","year":"1995","journal-title":"Cancer Nurs."},{"key":"ref_31","first-page":"347","article-title":"Oral hygiene measures for patients with cancer. I","volume":"3","author":"Daeffler","year":"1980","journal-title":"Cancer Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1159\/000262007","article-title":"Caries incidence, salivary flow rate and efficacy of fluoride gel treatment in irradiated patients","volume":"28","author":"Spak","year":"1994","journal-title":"Caries Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s005200050217","article-title":"Current practices in the oral management of the patient undergoing chemotherapy or bone marrow transplantation","volume":"7","author":"Barker","year":"1999","journal-title":"Support. Care Cancer"},{"key":"ref_34","unstructured":"American Academy of Pediatric Dentistry (2016). Guideline on Fluoride Therapy. Pediatric Dent., 38, 181\u2013184."},{"key":"ref_35","unstructured":"American Academy of Pediatric Dentistry (2017). Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents. Pediatric Dent., 15, 197\u2013204."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.cden.2007.10.001","article-title":"Considerations in the Pediatric Population with Cancer","volume":"52","author":"Hong","year":"2008","journal-title":"Dent. Clin. N. Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5005\/jcdp-10-3-1","article-title":"Anticariogenicity of casein phosphopeptide-amorphous calcium phosphate: A review of the literature","volume":"10","author":"Llena","year":"2009","journal-title":"J. Contemp. Dent. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.ijrobp.2004.12.051","article-title":"On the mechanism of salivary gland radiosensitivity","volume":"62","author":"Konings","year":"2005","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.tripleo.2004.04.009","article-title":"Double-blind randomized, placebo-controlled study of pilocarpine to salvage salivary gland function during radiotherapy of patients with head and neck cancer","volume":"98","author":"Gornitsky","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/coa.12488","article-title":"Trismus in patients with head and neck cancer: Etiopathogenesis, diagnosis and management","volume":"40","author":"Rapidis","year":"2015","journal-title":"Clin. Otolaryngol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1097\/01.mlg.0000171019.80351.46","article-title":"The degree and time-course assessment of radiation-induced trismus occurring after radiotherapy for nasopharyngeal cancer","volume":"115","author":"Wang","year":"2005","journal-title":"Laryngoscope"},{"key":"ref_42","unstructured":"(2018). Dental Management of Pediatric Patients Receiving Immunosuppressive Therapy and\/or Radiation Therapy. Pediatric Dent., 40, 392\u2013400."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/S1368-8375(01)00002-1","article-title":"Disturbances in craniofacial morphology in children treated for solid tumors","volume":"37","author":"Jahnukainen","year":"2001","journal-title":"Oral Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/oxfordjournals.ejo.a036004","article-title":"Facial growth and morphology in long-term survivors after bone marrow transplantation","volume":"11","author":"Forsberg","year":"1989","journal-title":"Eur. J. Orthod."},{"key":"ref_45","first-page":"2645","article-title":"Dentofacial development in long-term survivors of acute lymphoblastic leukemia","volume":"66","author":"Sonis","year":"1990","journal-title":"A Comp. Three Treat. Modalities Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/00000637-198311000-00010","article-title":"Effect of irradiation on facial growth: A 7- to 25-year follow-up","volume":"11","author":"Guyuron","year":"1983","journal-title":"Ann. Plast. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1597\/1545-1569_1992_029_0578_sapeom_2.3.co_2","article-title":"Social and psychological effects of major craniofacial deformity","volume":"29","author":"Pruzinsky","year":"1992","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1002\/1097-0142(19860515)57:10<2070::AID-CNCR2820571032>3.0.CO;2-G","article-title":"Late effects after treatment of twenty children with soft tissue sarcomas of the head and neck","volume":"57","author":"Fromm","year":"1986","journal-title":"Cancer"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"935","DOI":"10.2214\/ajr.127.6.935","article-title":"Effects of radiation therapy on growing long bones","volume":"127","author":"Kuhns","year":"1976","journal-title":"Am. J. Roentgenol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/(SICI)1096-911X(199701)28:1<27::AID-MPO6>3.0.CO;2-V","article-title":"Growth and growth hormone secretion after treatment for childhood non-Hodgkin\u2019s lymphoma","volume":"28","author":"Samuelsson","year":"1997","journal-title":"Med. Pediatric Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0165-5876(98)00028-7","article-title":"The effects of radiation on craniofacial skeletal growth: A quantitative study","volume":"45","author":"Denys","year":"1998","journal-title":"Int. J. Pediatric Otorhinolaryngol."},{"key":"ref_52","first-page":"Ze01","article-title":"Orthodontic Therapy for Paediatric Cancer Survivors: A Review","volume":"11","author":"Mishra","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S0889-5406(96)70068-9","article-title":"Orthodontic management of patients with hematologic malignancies","volume":"109","author":"Sheller","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1177\/154405910708600510","article-title":"In vitro evaluation of corrosion and cytotoxicity of orthodontic brackets","volume":"86","author":"Costa","year":"2007","journal-title":"J. Dent. Res."},{"key":"ref_55","first-page":"140","article-title":"Pure titanium orthodontic brackets","volume":"30","author":"Hamula","year":"1996","journal-title":"J. Clin. Orthod."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"469.e1","DOI":"10.1016\/j.ajodo.2005.10.007","article-title":"Cellular, molecular, and tissue-level reactions to orthodontic force","volume":"129","author":"Krishnan","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ejo\/16.3.223","article-title":"Evaluation of root resorption in relation to two orthodontic treatment regimes. A clinical experimental study","volume":"16","author":"Levander","year":"1994","journal-title":"Eur. J. Orthod."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1067\/mod.2001.118102","article-title":"Orthodontic treatment in long-term survivors after pediatric bone marrow transplantation","volume":"120","author":"Ulmner","year":"2001","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_59","first-page":"173","article-title":"Oral complications of cancer therapies. Chronic dental complications","volume":"9","author":"Rosenberg","year":"1990","journal-title":"NCI Monogr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0030-4220(06)80115-5","article-title":"Micrognathia after radiation therapy for childhood facial tumors: Report of two cases with long-term follow-up","volume":"77","author":"Kaste","year":"1994","journal-title":"Oral Surg. Oral Med. Oral Pathol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1002\/pbc.26061","article-title":"Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma","volume":"63","author":"Lockney","year":"2016","journal-title":"Pediatric Blood Cancer"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/(SICI)1096-911X(200006)34:6<413::AID-MPO6>3.0.CO;2-4","article-title":"Late effects of therapy in 94 patients with localized rhabdomyosarcoma of the orbit: Report from the Intergroup Rhabdomyosarcoma Study (IRS)-III, 1984\u20131991","volume":"34","author":"Raney","year":"2000","journal-title":"Med. Pediatric Oncol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/22\/12158\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:32:50Z","timestamp":1760167970000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/22\/12158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,19]]},"references-count":62,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["ijerph182212158"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182212158","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,19]]}}}