Necrotizing

sialometaplasia

Necrotizing sialometaplasia (NS) is a

benign, ulcerative lesion, usually located
towards the back of the hard palate. It is
thought to be caused by ischemic necrosis
(death of tissue due to lack of blood
supply) of minor salivary glands in
response to trauma. Often painless, the
condition is self-limiting and should heal in
6–10 weeks.
 Necrotizing sialometaplasia

Specialty ENT surgery

Although entirely benign and requiring no

treatment, due to its similar appearance to
oral cancer, it is sometimes misdiagnosed
as malignant. Therefore, it is considered
an important condition, despite its rarity.

Signs and symptoms

The condition most commonly is located
at the junction of the hard and soft
palate.[1] However, the condition may arise
anywhere minor salivary glands are
located.[nb 1] It has also been occasionally
reported to involve the major salivary
glands.[2][3] It may be present only on one
side, or both sides.[1] The lesion typically is
1–4 cm in diameter.[4]

Initially, the lesion is a tender,

erythematous (red) swelling. Later, in the
ulcerated stage, the overlying mucosa
breaks down to leave a deep, well-
circumscribed ulcer which is yellow-gray in
color and has a lobular base.[1]

There is usually only minor pain,[1] and the

condition is often entirely painless. There
may be prodromal symptoms similar to flu
before the appearance of the lesion.[4]

Causes
The exact cause of the condition is
unknown.[4][5] There is most evidence to
support vascular infarction and ischemic
necrosis of salivary gland lobules as a
mechanism for the condition.[6]
Experimentally, local anaesthetic
injections and tying of the arteries is
reported to trigger the development of
tissue changes similar to NS in lab rats.[6]
Factors which are thought to cause this
ischemia are listed below, however
sometimes there is no evident
predisposing factor or initiating event.[6]

Trauma[4] e.g. during intubation,[6] or

surgical procedures[6]
Local anesthetic injection[4]
Smoking[4]
Alcohol[6]
Diabetes mellitus[4]
 Vascular disease,[4] (e.g.
arteriosclerosis)[5]
Pressure from a dental prosthesis[4]
Allergy[5]
Bulimia[2]
Infection[6]
Ionizing radiation[6]

Diagnosis
Differentiation between this and SCC
would be based on a history of recent
trauma or dental treatment in the area.

Immunohistochemistry may aid the

diagnosis. If the lesion is NS, there will be
focal to absent immunoreactivity for p53,
low immunoreactivity for MIB1 (Ki-67), and
the presence of 4A4/p63- and calponin-
positive myoepithelial cells.[2]

Treatment
No surgery is required.[4]

Prognosis
Healing is prolonged, and usually takes 6–
10 weeks.[1] The ulcer heals by secondary
intention.[7]

Epidemiology
The condition is rare.[8][9] The typical age
range of those affected by the condition is
about 23–66 years of age.[4] It usually
occurs in smokers.[9] The male to female
ratio has been reported as 1.95:1,[5] and
2.31:1.[10]

History
NS was first reported by Abrams et al. in
1973.[11][6]

Notes
1. Minor salivary glands are found in most
mucosal surfaces in the mouth, apart from
the front third of the hard palate, the front
 third of the dorsal surface of the tongue,
and the attached gingiva. (see Hupp et al.
2013, p.395)

References
1. Regezi JA; Scuibba JJ; Jordan RCK (2012).
Oral pathology : clinical pathologic
correlations (6th ed.). St. Louis, Mo.:
Elsevier/Saunders. p. 191. ISBN 978-1-
4557-0262-6.
2. Carlson, DL (May 2009). "Necrotizing
sialometaplasia: a practical approach to the
diagnosis". Archives of Pathology &
Laboratory Medicine. 133 (5): 692–8.
doi:10.1043/1543-2165-133.5.692 .
PMID 19415943 .
3. Tsuji, T; Nishide, Y; Nakano, H; Kida, K;
Satoh, K (2014). "Imaging findings of
necrotizing sialometaplasia of the parotid
gland: case report and literature review" .
Dentomaxillofacial Radiology. 43 (6):
20140127. doi:10.1259/dmfr.20140127 .
PMC 4141672 . PMID 24850145 .
4. Hupp JR; Tucker MR; Ellis E (19 March
2013). Contemporary Oral and Maxillofacial
Surgery (6th ed.). Elsevier Health Sciences.
pp. 412–414. ISBN 978-0-323-22687-5.
5. Schmidt-Westhausen, A; Philipsen, HP;
Reichart, PA (1991). "[Necrotizing
sialometaplasia of the palate. Literature
report of 3 new cases]". Deutsche
Zeitschrift für Mund-, Kiefer- und Gesichts-
Chirurgie. 15 (1): 30–4. PMID 1814663 .
 . Barnes L (2008). Surgical pathology of the
head and neck (3rd ed.). New York:
Informa Healthcare. pp. 491–493.
ISBN 9780849390234.
7. Imbery, TA; Edwards, PA (July 1996).
"Necrotizing sialometaplasia: literature
review and case reports". Journal of the
American Dental Association. 127 (7):
1087–92.
doi:10.14219/jada.archive.1996.0334 .
PMID 8754467 .
 . Janner, SF; Suter, VG; Altermatt, HJ;
Reichart, PA; Bornstein, MM (May 2014).
"Bilateral necrotizing sialometaplasia of the
hard palate in a patient with bulimia: a case
report and review of the literature".
Quintessence International. 45 (5): 431–7.
doi:10.3290/j.qi.a31543 . PMID 24634907 .
9. Scully C (2013). Oral and maxillofacial
medicine: the basis of diagnosis and
treatment (3rd ed.). Edinburgh: Churchill
Livingstone. p. 405. ISBN 9780702049484.
10. Jainkittivong, A; Sookasam, M; Philipsen,
HP (1989). "Necrotizing sialometaplasia:
review of 127 cases". The Journal of the
Dental Association of Thailand. 39 (1): 11–
6. PMID 2699611 .
11. Abrams, AM; Melrose, RJ; Howell, FV (July
1973). "Necrotizing sialometaplasia. A
disease simulating malignancy" . Cancer.
32 (1): 130–5. doi:10.1002/1097-
0142(197307)32:1<130::aid-
cncr2820320118>3.0.co;2-8 .
PMID 4716764 .

External links
Classification ICD-10: K11.8 • D

MeSH: D012797 •

DiseasesDB: 31434

External resources eMedicine: derm/656

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