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In this case of a 45-year-old woman, who attended the primary care service at Birmingham Dental Hospital with widespread ulceration affecting the hard palate, histopathological, haematological and immunological testing confirmed a diagnosis of necrotizing sialometaplasia (NS), a rare benign minor salivary gland condition. The aetiology of NS is unknown; however, it is thought to represent necrosis of the mucoserous acini due to ischaemia. The clinical features of NS are similar to of squamous cell carcinoma and histopathological investigations may be required to exclude malignancy.
CPD/Clinical Relevance: The article highlights the importance of recognizing necrotizing sialometaplasia to prevent misdiagnosis and ensure correct management is undertaken.
Article
Necrotizing sialometaplasia (NS) is a rare, rapidly developing benign minor salivary gland disease of inflammatory origin. The term necrotizing sialometaplasia is used to describe the most consistent feature of the condition: necrosis of the salivary glands causing mucosal breakdown. It is thought to be caused by trauma to the mucoserous glands.
The clinical features of NS are similar to neoplastic changes seen in oral squamous cell carcinoma and muco-epidermoid carcinoma, hence prompt histopathology may be warranted to eliminate malignancy. The case of a patient who presented with necrotizing sialometaplasia and was treated with debridement and antimicrobial mouthwash is presented.
A 45-year-old female attended the primary care service at Birmingham Dental Hospital for urgent care, with a complaint of acute pain in the palate for the previous 2 weeks. The patient initially experienced symptoms of a sore throat, persistent cough and sought medical attention (from her general medical practitioner and out of hours A&E) on numerous occasions, where she was prescribed morphine and discharged on oral antibiotics (doxycycline). She reported no history of chemical, thermal or physical trauma to the palate. She developed an extensive ulcer affecting the palate, and progressive worsening of symptoms and distress. The patient's medical and social history revealed she had a gastric band placed several years previously, suffered from gastro-oesophageal reflux and was being monitored for hypertension; however, she was not taking any medications. In addition to this, she reported smoking around 10 cigarettes a day.
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