Necrotizing Sialometaplasia: A Diagnostic Challenge to Oral Physicians

Abstract

Necrotizing sialometaplasia is a rare, reactive, self-limiting disorder affecting a minor salivary gland that clinically mimics malignancy. Chronic smoking, alcohol use, trauma to the hard palate caused by local anesthetic injection due to the vasoconstrictive action of adrenaline in local anesthetic, topical application of nonsteroidal anti-inflammatory drugs like flurbiprofen spray used in bronchial asthma, oral intubation procedures for general anesthesia, ill-fitting dentures, bulimia nervosa, and minor salivary gland tumors are some of the contributing factors linked to its development. In this article, we discuss a rare, reactive, selflimiting condition affecting minor salivary gland, necrotizing sialometaplasia that occurred on the right posterolateral hard palate region in a 57-year-old male chronic smoker, diagnosed by oral medicine specialist by clinical findings and radiological evaluation by cone beam computed tomography that healed rapidly in three days by itself without any treatment, that prevented unwanted biopsy or surgery.

Zygomycosis of the Oral Cavity in a Main Referral Centre in Malaysia: A Case Series (1967-2021)

“…Another close mimic is necrotizing sialometaplasia. Both conditions may appear as destructive palatal lesions, but necrotizing sialometaplasia is a self-limiting condition with a rapid onset and remains more localized [27]. In the presence of exposed bone, the differential diagnosis includes osteonecrosis.…”

Atypical Presentation of Necrotizing Sialometaplasia of the Hard Palate: A Diagnostic Dilemma

“…All teeth are non-carious and vital on cold test and electric pulp test with no periodontal diseases as well (Figure 1). The differential diagnosis includes minor salivary gland tumors, such as squamous cell carcinoma, mucoepidermoid carcinoma, Warthin's tumor, and adenoid cystic carcinoma [3]. A contrast-enhanced computed tomography (CECT) scan was done, revealing the presence of an ill-defined peripherally enhancing hypodense soft tissue lesion at the margin of the soft and hard palate, more on the right side.…”

“…Due to the lack of understanding of this lesion and its histopathological similarities with carcinomas, with mucoepidermoid carcinoma in particular, the diagnosis of this lesion is challenging [3]. Necrotizing sialometaplasia is only reported in 0.03% of biopsied oral lesions, with a predominance in Whites and an age prevalence between 17 and 80 years, with slight male predominance at a 2:1 ratio [4,5].…”