Necrotizing Sialometaplasia of the Hard Palate in a Patient Treated with Topical Nonsteroidal Anti-Inflammatory Drug

Abstract

Necrotizing sialometaplasia is a rare, benign, self-limiting, necrotizing process involving the minor salivary glands, mainly the mucoserous glands of the hard palate. It is thought to be the result of an ischemic event of the vasculature supplying the salivary gland lobules. Some predisposing factors such as smoking, use of alcohol, denture wearing, recent surgery, traumatic injuries, respiratory infections, systemic diseases bulimia, and anorexia have been described. Herein we present a case of necrotizing sialometaplasia of the hard palate in a patient without known predisposing factors, in our opinion, resulting from the use of topical anti-inflammatory drug. After diagnosis, the patient underwent treatment with chlorhexidine gluconate and a full palatal acrylic guard to protect the exposed bone from food residues during meals. After the sixth week the lesion regressed.

Necrotizing sialometaplasia can hide the presence of salivary gland tumors: A case series

“…Such ischemic process may be induced by direct trauma (Birkholz et al, ; Brannon et al, ; Giles, ), local anesthetics (Brannon et al, ; Grillon & Lally, ; Shigematsu, Shigematsu, Noguchi, & Fujita, ), topical treatment with non‐steroidal anti‐inflammatory drugs (Gatti, Broccardo, Poglio, & Benech, ), cocaine abuse (Alfaya et al, ; Close & Cowan, ), radiation (McCullough, Rye, & Redman, ), alcohol (Brannon et al, ; Dunlap & Barker, ), tobacco smoking (Anneroth & Hansen, ; Brannon et al, ), upper respiratory tract infections, allergy (Brannon et al, ; Samit, Mashberg, & Greene, ), oral intubation (Romagosa et al, ), and surgical procedures (Batsakis & Manning, ). Mandel and co‐workers described a patient with NS resulting from impaired blood supply due to sickle‐cell anemia (Mandel, Kaynar, & DeChiara, ).…”

Necrotizing Sialometaplasia: A Diagnostic Challenge to Oral Physicians

“…[ 2 ] Trauma from intubation procedure for general anesthesia also can result in necrotizing sialometaplasia, bulimia nervosa, an eating disorder with marked binge eating followed by purging [ 3 , 4 ]. Gatti A et al described a necrotizing sialometaplasia caused by excessive use of the nonsteroidal anti-inflammatory drug Flurbiprofen oral spray that contained alcohol six times once a day for five weeks for prevention of sore throat [ 5 ]. Senapati S et al reported its occurrence due to immune-mediated vasculitis such as granulomatosis with polyangiitis Wegener’s disease [ 6 ].…”

A Case of Necrotizing Sialometaplasia of the Hard Palate Treated with Tranexamic Acid and Sodium Azulene Sulfonate

“…The latter leads to infarction of the minor salivary gland acini with necrosis, in ammation, and salivary duct metaplasia 4 . Numerous risk factors have been described to explain the onset of local ischemia in the minor salivary glands of the hard palate 5 . Smokers reportedly have a higher prevalence of palatal lesions 6 .…”

“…The treatment of necrotizing sialometaplasia does not require surgery 5 . The treatment of this lesion is avoidable due to its tendency for spontaneous healing and depends on whether the lesion is symptomatic 7 .…”