Necrotizing Sialometaplasia Clinical Presentation

  • Author: John Svirsky, DDS; Chief Editor: William D James, MD   more...
 
Updated: May 15, 2012
 

History

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.

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Physical

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.

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Causes

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.

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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Coauthor(s)

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 and American Association for Cancer Research

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

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 and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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Initial presentation.
Three weeks later after biopsy.
At 6 weeks.
Nine weeks. Salivary gland infarction.
 
 
 
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