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Enhancing diagnostic precision: a case study on necrotizing sialometaplasia Rosheen Fatima Julia Radecki Dental Update 2025 52:6, 387-389.
Authors
RosheenFatima
BDS, BSc (Hons), Dental Core Trainee in Oral and Maxillofacial Surgery, Restorative Dentistry and Orthodontics, Croydon University Hospital, Croydon Health Services NHS Trust, London
Necrotizing sialometaplasia (NS) is a rare, benign inflammatory condition of the minor salivary glands that can mimic malignancy, posing a diagnostic challenge. This case report describes a 40-year-old male smoker who presented with a painful ulcer on the palate, initially misdiagnosed as a fungal infection. Clinical examination revealed a 1-cm punched-out palatal lesion near infected upper teeth. Histological analysis of a biopsy confirmed NS, with no malignancy observed. The patient showed significant healing by the 7-week follow-up with no active treatment required. This case underscores the importance of biopsy in differentiating NS from malignancy, especially in high-risk patients.
CPD/Clinical Relevance: Correct diagnosis of necrotizing sialometaplasia may be difficult but is needed to ensure appropriate management.
Article
Necrotizing sialometaplasia (NS), initially described by Abrams in 1973, is a reactive necrotizing inflammatory condition of the minor salivary glands.1 It can clinically mimic malignant neoplasms such as squamous cell carcinoma and mucoepidermoid carcinoma, making it a potential diagnostic challenge.2
While its exact cause remains unknown, the most widely accepted theory proposes that ischaemia or compromised blood supply to the salivary gland is the underlying cause. Various factors can cause the ischaemic injury, including local trauma, local anaesthesia, ill-fitting dentures, smoking, alcohol consumption, radiation, allergies, upper respiratory tract infection, intubation, surgical interventions in the area and chronic vomiting episodes.2–4
Although NS can involve any salivary gland site, it mainly affects the minor salivary glands located within the palatal mucosa.
A 40-year-old, medically fit, male, long-term smoker (15 cigarettes/day), was referred by his GP to the oral and maxillofacial surgery (OMFS) department on an urgent cancer referral pathway for an erythematous, painful ulcer that had been present for more than 3 weeks. Four weeks before presenting to the OMFS department, the patient had a chest infection for which he had been prescribed a course of amoxicillin antibiotics. He then noticed a painful ulcer developing overnight on the left side of his palate. The patient initially visited the emergency department, where a tentative diagnosis of a fungal infection was made, and he was prescribed nystatin oral suspension. However, his GP later ruled out a fungal infection and referred the patient urgently to the OMFS department.
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