ABSTRACT
Necrotising sialometaplasia (NS) is a rare condition, with a limited scientific evidence base regarding its aetiology and pathophysiology. Diagnosing NS demands extensive investigatory tests. Their accuracy is vital in order to exclude oral malignancy and prevent unwarranted, invasive management.Within Birmingham Dental Hospital, a 22-year-old, South Asian woman presented with generalised pain from the lower right third molar extending to involve the palate, to which the patient's general medical practitioner previously attributed to a viral upper respiratory infection. Clinical examination revealed bilateral erythematous: non-ulcerated, palatal swellings (10 mm x 5 mm) at the greater palatine foramina. Following extensive investigations, the challenging definitive diagnoses of two distinct pathologies were made: non-ulcerative NS and pericoronitis.This case report describes the successful diagnosis and management of non-ulcerating NS, an 'atypical' presentation of a rare condition, that was confounded by a simultaneous episode of pericoronitis - a presentation not previously documented within scientific literature.
Subject(s)
Pericoronitis , Sialometaplasia, Necrotizing , Female , Humans , Young Adult , Asian People , Pericoronitis/complications , Pericoronitis/diagnosis , Pericoronitis/therapy , Sialometaplasia, Necrotizing/complications , Sialometaplasia, Necrotizing/diagnosis , Sialometaplasia, Necrotizing/therapy , South Asian PeopleABSTRACT
OBJECTIVES: The aim of this report was the clinical and histologic characterization of necrotizing sialometaplasia. STUDY DESIGN: We performed a retrospective case series analysis. RESULTS: The study included 4 women 29-71 years old. Possible contributing factors (drugs, alcohol abuse, bulimia, smoking, and pancreatic cancer) were identified. Patients presented with unilateral or bilateral rapidly progressing painful palatal ulcers. Necrotic salivary glands and inflammation were universal microscopic features; ductal metaplasia was present in only 1 case. Thrombosis and heavy fungal and bacterial overgrowth were observed in 1 case. In 3 of the cases the lesions healed within 4-6 weeks under conservative supportive care, whereas in 1 case persistent enlargement up to 25 mm diameter was observed. Surgical debridement combined with a palatal guard resulted in complete healing within 12 weeks. CONCLUSIONS: Significant variations may be observed in both clinical and microscopic manifestations of necrotizing sialometaplasia. Although this disease is considered to be self-limiting in the majority of cases, surgical intervention can be considered in unusually large cases.
Subject(s)
Sialometaplasia, Necrotizing/pathology , Adult , Aged , Humans , Retrospective Studies , Sialometaplasia, Necrotizing/etiology , Sialometaplasia, Necrotizing/therapyABSTRACT
In this article we present 2 cases of necrotizing sialometaplasia (NS) associated with angiocentric lymphoma of the midline. Immunohistochemical analysis confirmed a T-cell origin, and in situ hybridization in one case revealed its relationship to Epstein-Barr virus. These findings suggest that vascular occlusion by the neoplastic cells produces ischemia, which leads to local infarction contributing to the salivary gland lesion. To our knowledge, the association between angiocentric lymphoma and NS has been previously reported in only one instance, and we suggest that this particular type of lymphoma should be added to the list of related conditions for NS.
Subject(s)
Epstein-Barr Virus Infections/complications , Lymphoma, T-Cell/complications , Palatal Neoplasms/complications , Paranasal Sinus Neoplasms/complications , Sialometaplasia, Necrotizing/diagnosis , Sialometaplasia, Necrotizing/etiology , Adult , Epstein-Barr Virus Infections/diagnosis , Female , Herpesvirus 4, Human/genetics , Herpesvirus 4, Human/isolation & purification , Humans , In Situ Hybridization , Lymphoma, T-Cell/pathology , Lymphoma, T-Cell/therapy , Lymphoma, T-Cell/virology , Male , Palatal Neoplasms/pathology , Palatal Neoplasms/therapy , Palatal Neoplasms/virology , Palate , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/therapy , Paranasal Sinus Neoplasms/virology , Salivary Glands/blood supply , Salivary Glands/pathology , Sialometaplasia, Necrotizing/pathology , Sialometaplasia, Necrotizing/therapyABSTRACT
Necrotizing sialometaplasia is a non-neoplastic self-limiting inflammatory-ulcerous condition of the minor salivary glands. It is reported to appear in the oral cavity at every area where minor salivary glands exist, particularly those of the palate. Necrotizing sialometaplasia is a very rare disease that spontaneously develops with fearsome features. It is thought to be due to infarction of minor salivary glands, and heals in a few weeks, without any treatment. The clinical and histopathological features of necrotizing sialometaplasia often simulate those of such malignancies as squamosus cell carcinoma or mucoepidermoid carcinoma. Familiarity with necrotizing sialometaplasia and correct differential diagnosis are paramount in avoiding misdiagnosis and inappropriate treatment.
Subject(s)
Sialometaplasia, Necrotizing , Adult , Anti-Bacterial Agents/therapeutic use , Chlorhexidine/analogs & derivatives , Chlorhexidine/therapeutic use , Doxycycline/therapeutic use , Female , Humans , Male , Middle Aged , Mouthwashes/therapeutic use , Sialometaplasia, Necrotizing/diagnosis , Sialometaplasia, Necrotizing/therapy , Tetracycline/therapeutic use , Treatment OutcomeABSTRACT
Noninflammatory, non-neoplastic diseases comprise a diverse group of disorders that can present in a variety of ways. In general, a careful history will sharply focus the diagnostic possibilities. Although the diagnosis usually will be certain following the physical examination, additional testing may be needed to facilitate treatment planning. Sialolithiasis, cystic lesions, radiation injury, treatment to the parotid glands, sialodenosis, and other disorders are discussed in this article.
Subject(s)
Cysts/diagnosis , Parotid Diseases/diagnosis , Salivary Gland Calculi/diagnosis , Sialadenitis/diagnosis , Sialometaplasia, Necrotizing/diagnosis , Cysts/therapy , Humans , Parotid Diseases/therapy , Salivary Gland Calculi/therapy , Sialadenitis/therapy , Sialometaplasia, Necrotizing/therapy , Tomography, X-Ray ComputedABSTRACT
A case of necrotizing sialometaplasia in a 29-year-old man is reported. Characterized by large, deep, well-demarcated ulcerations on the hard palate and other areas where salivary gland tissue is found, the condition is benign and resolves spontaneously. The cause is believed to be infarctive.
