Medscape is available in 5 Language Editions – Choose your Edition here.


Necrotizing Sialometaplasia Clinical Presentation

  • Author: John A Svirsky, DDS, MEd; Chief Editor: William D James, MD  more...
Updated: Jun 10, 2016


Most cases of necrotizing sialometaplasia appear to arise spontaneously, whereas others are associated with a history of trauma, vomiting,[15, 16] radiation therapy, or surgery.[15] An association with neoplasia, such as parotid tumors, false vocal cord squamous cell carcinoma, and maxillary sinus carcinoma, is also reported. Cases associated with inflammatory conditions such as relapsing polychondritis and acute and chronic sinusitis have been noted to occur in the subglottic and sinus regions, respectively.



Necrotizing sialometaplasia manifests as a swelling with or without ulceration in anatomic sites that have mucous or serous glandular tissue.

The typical clinical presentation of necrotizing sialometaplasia is that of a crateriform ulcer of the palate that simulates a malignant process. These ulcerated lesions are 1-3 cm and are usually unilateral, but bilateral synchronous lesions and metachronous lesions can occur.[17, 18, 19]

Some lesions of necrotizing sialometaplasia may present as a submucosal swelling, without ulceration of the overlying mucosa. An intact surface mucosa may be noted in an evolving lesion at the time of diagnosis, although most cases are accompanied by mucosal ulceration. Erosion of the palatal bone may occur in either ulcerated or nonulcerated lesions.

Examination of a biopsy specimen is usually required to establish the correct diagnosis and to exclude a malignant or infectious process or an inflammatory condition such as Wegener granulomatosis. Extranodal lymphoma also may be considered in the clinical differential diagnosis of a palatal swelling or ulceration.



In most cases of necrotizing sialometaplasia, the etiology is believed to be related to vascular ischemia. Cases are reported in which vascular compression is caused by a necrotic myocutaneous reconstruction flap, embolization from carotid endarterectomy, sickle cell anemia,[20] Buerger disease,[21] or Raynaud phenomenon.[21]

The association of adjacent neoplasia that results in ischemic necrosis of the glandular elements and the histologic features of necrotizing sialometaplasia supports this pathogenic mechanism. In an experimental study in a rat model, local anesthetic injections induced necrotizing sialometaplasia.[22] Tobacco use is suggested as a possible etiologic risk factor for necrotizing sialometaplasia.

Contributor Information and Disclosures

John A Svirsky, DDS, MEd Director of Oral Pathology Diagnostic Service, Professor of Oral and Maxillofacial Pathology, Virginia Commonwealth University School of Dentistry

John A Svirsky, DDS, MEd is a member of the following medical societies: American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.


John E Fantasia, DDS Chief, Division of Oral Pathology, Department of Dermatology, Long Island Jewish Medical Center, North Shore-Long Island Jewish Health System

John E Fantasia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Josephine Wu, DDS Assistant Director, Molecular Pathology Laboratory, Department of Pathology, Mount Sinai School of Medicine; Consulting Staff, Division of Oral and Maxillofacial Pathology, Department of Dental Medicine, Long Island Jewish Medical Center

Josephine Wu, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Association for Cancer Research

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Abdul-Ghani Kibbi, MD Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

  1. Abrams AM, Melrose RJ, Howell FV. Necrotizing sialometaplasia. A disease simulating malignancy. Cancer. 1973 Jul. 32(1):130-5. [Medline].

  2. Franchi A, Gallo O, Santucci M. Pathologic quiz case 1. Necrotizing sialometaplasia obscuring recurrent well-differentiated squamous cell carcinoma of the maxillary sinus. Arch Otolaryngol Head Neck Surg. 1995 May. 121(5):584, 586. [Medline].

  3. Schmidt-Westhausen A, Philipsen HP, Reichart PA. [Necrotizing sialometaplasia of the palate. Literature report of 3 new cases]. Dtsch Z Mund Kiefer Gesichtschir. 1991 Jan-Feb. 15(1):30-4. [Medline].

  4. Batsakis JG, Manning JT. Necrotizing sialometaplasia of major salivary glands. J Laryngol Otol. 1987 Sep. 101(9):962-6. [Medline].

  5. Zschoch H. [Mucus gland infarct with squamous epithelial metaplasia in the lung. A rare site of so-called necrotizing sialometaplasia]. Pathologe. 1992 Feb. 13(1):45-8. [Medline].

  6. Abrams AM. Necrotizing sialometaplasia of the nasal cavity. Otolaryngol Head Neck Surg. 1986 Mar. 94(3):416. [Medline].

  7. Chen KT. Necrotizing sialometaplasia of the nasal cavity. Am J Otolaryngol. 1982 Nov-Dec. 3(6):444-6. [Medline].

  8. Walker GK, Fechner RE, Johns ME, Teja K. Necrotizing sialometaplasia of the larynx secondary to atheromatous embolization. Am J Clin Pathol. 1982 Feb. 77(2):221-3. [Medline].

  9. Wenig BM. Necrotizing sialometaplasia of the larynx. A report of two cases and a review of the literature. Am J Clin Pathol. 1995 May. 103(5):609-13. [Medline].

  10. Romagosa V, Bella MR, Truchero C, Moya J. Necrotizing sialometaplasia (adenometaplasia) of the trachea. Histopathology. 1992 Sep. 21(3):280-2. [Medline].

  11. Bell GW, Loukota RA. Necrotizing sialometaplasia coincident with ipsilateral infarcted antral polyps. Br J Oral Maxillofac Surg. 1996 Feb. 34(1):129-31. [Medline].

  12. Hurt MA, Díaz-Arias AA, Rosenholtz MJ, Havey AD, Stephenson HE Jr. Posttraumatic lobular squamous metaplasia of breast. An unusual pseudocarcinomatous metaplasia resembling squamous (necrotizing) sialometaplasia of the salivary gland. Mod Pathol. 1988 Sep. 1(5):385-90. [Medline].

  13. Mesa ML, Gertler RS, Schneider LC. Necrotizing sialometaplasia: frequency of histologic misdiagnosis. Oral Surg Oral Med Oral Pathol. 1984 Jan. 57(1):71-3. [Medline].

  14. Brannon RB, Fowler CB, Hartman KS. Necrotizing sialometaplasia. A clinicopathologic study of sixty-nine cases and review of the literature. Oral Surg Oral Med Oral Pathol. 1991 Sep. 72(3):317-25. [Medline].

  15. Aframian D, Milhem I I, Kirsch G, Markitziu A. Necrotizing Sialometaplasia after Silastic Ring Vertical Gastroplasty: Case Report and Review of Literature. Obes Surg. 1995 May. 5(2):179-182. [Medline].

  16. Schöning H, Emshoff R, Kreczy A. Necrotizing sialometaplasia in two patients with bulimia and chronic vomiting. Int J Oral Maxillofac Surg. 1998 Dec. 27(6):463-5. [Medline].

  17. Rossie KM, Allen CM, Burns RA. Necrotizing sialometaplasia: a case with metachronous lesions. J Oral Maxillofac Surg. 1986 Dec. 44(12):1006-8. [Medline].

  18. Stafford RF, Sonis ST, Shklar G. Bilateral necrotizing sialometaplasia: a case report. J Oral Med. 1981 Apr-Jun. 36(2):28-30. [Medline].

  19. Niedzielska I, Janic T, Markowski J. Bilateral localization of necrotizing sialometaplasia: a case report. Cases J. 2009 Sep 8. 2:9068. [Medline]. [Full Text].

  20. Mandel L, Kaynar A, DeChiara S. Necrotizing sialometaplasia in a patient with sickle-cell anemia. J Oral Maxillofac Surg. 1991 Jul. 49(7):757-9. [Medline].

  21. Rye LA, Calhoun NR, Redman RS. Necrotizing sialometaplasia in a patient with Buerger's disease and Raynaud's phenomenon. Oral Surg Oral Med Oral Pathol. 1980 Mar. 49(3):233-6. [Medline].

  22. Shigematsu H, Shigematsu Y, Noguchi Y, Fujita K. Experimental study on necrotizing sialometaplasia of the palate in rats. Role of local anesthetic injections. Int J Oral Maxillofac Surg. 1996 Jun. 25(3):239-41. [Medline].

  23. Ben-Izhak O, Ben-Arieh Y. Necrotizing squamous metaplasia in herpetic tracheitis following prolonged intubation: a lesion similar to necrotizing sialometaplasia. Histopathology. 1993 Mar. 22(3):265-9. [Medline].

  24. Aframian DJ. Necrotizing sialometaplasia-a practical approach to the diagnosis. Arch Pathol Lab Med. 2010 Jan. 134(1):17. [Medline].

  25. Granich MS, Pilch BZ. Necrotizing sialometaplasia in the setting of acute and chronic sinusitis. Laryngoscope. 1981 Sep. 91(9 Pt 1):1532-5. [Medline].

  26. Granick MS, Solomon MP, Benedetto AV, Hannegan MW, Sohn M. Necrotizing sialometaplasia masquerading as residual cancer of the lip. Ann Plast Surg. 1988 Aug. 21(2):152-4. [Medline].

  27. Jensen JL. Idiopathic diseases. Ellis GL, Auclair PL, Gnepp DR, eds. Surgical Pathology of the Salivary Glands. Philadelphia, Pa: WB Saunders; 1991. 60-82.

  28. King DT, Barr RJ. Syringometaplasia: mucinous and squamous variants. J Cutan Pathol. 1979 Aug. 6(4):284-91. [Medline].

  29. Krishna S, Bk R. Necrotizing sialometaplasia of palate: a case report. Imaging Sci Dent. 2011 Mar. 41(1):35-8. [Medline]. [Full Text].

  30. Nilsen R, Bernhoft CH, Gilhuus-Moe O. Necrotizing sialometaplasia. Int J Oral Surg. 1978 Dec. 7(6):580-4. [Medline].

  31. Oliveira Alves MG, Kitakawa D, Carvalho YR, et al. Necrotizing sialometaplasia as a cause of a non-ulcerated nodule in the hard palate: a case report. J Med Case Reports. 2011. 5:406. [Medline].

  32. Pulse CL, Lebovics RS, Zegarelli DJ. Necrotizing sialometaplasia: report of a case after lower lip mucocele excision. J Oral Maxillofac Surg. 2000 Dec. 58(12):1419-21. [Medline].

  33. Russell JD, Glover GW, Friedmann I. Necrotizing sialometaplasia. J Laryngol Otol. 1992 Jun. 106(6):569-71. [Medline].

  34. Sneige N, Batsakis JG. Necrotizing sialometaplasia. Ann Otol Rhinol Laryngol. 1992 Mar. 101(3):282-4. [Medline].

  35. Taxy JB. Necrotizing squamous/mucinous metaplasia in oncocytic salivary gland tumors. A potential diagnostic problem. Am J Clin Pathol. 1992 Jan. 97(1):40-5. [Medline].

Initial presentation.
Three weeks later after biopsy.
At 6 weeks.
Nine weeks. Salivary gland infarction.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.