Necrotizing sialometaplasia |
Classification and external resources |
ICD-10 |
K11.8 |
DiseasesDB |
31434 |
eMedicine |
derm/656 |
MeSH |
D012797 |
[edit on Wikidata]
|
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.
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.
Contents
- 1 Signs and symptoms
- 2 Causes
- 3 Diagnosis
- 4 Treatment
- 5 Prognosis
- 6 Epidemiology
- 7 History
- 8 Notes
- 9 References
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
- ^ 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
- ^ a b c d e 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.
- ^ a b c 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.
- ^ 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. PMID 24850145.
- ^ a b c d e f g h i j k 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.
- ^ a b c d Schmidt-Westhausen, A; Philipsen, HP; Reichart, PA (1991). "[Necrotizing sialometaplasia of the palate. Literature report of 3 new cases].". Deutsche Zeitschrift fur Mund-, Kiefer- und Gesichts-Chirurgie 15 (1): 30–4. PMID 1814663.
- ^ a b c d e f g h i Barnes L (2008). Surgical pathology of the head and neck (3rd ed.). New York: Informa Healthcare. pp. 491–493. ISBN 9780849390234.
- ^ Imbery, TA; Edwards, PA (July 1996). "Necrotizing sialometaplasia: literature review and case reports.". Journal of the American Dental Association (1939) 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 (Berlin, Germany : 1985) 45 (5): 431–7. doi:10.3290/j.qi.a31543. PMID 24634907.
- ^ a b Scully C (2013). Oral and maxillofacial medicine: the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. p. 405. ISBN 9780702049484.
- ^ 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.
- ^ 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.
Oral and maxillofacial pathology (K00–K06, K11–K14, 520–525, 527–529)
|
|
Lips
|
|
- Cheilitis
- Actinic
- Angular
- Plasma cell
- Cleft lip
- Congenital lip pit
- Eclabium
- Herpes labialis
- Macrocheilia
- Microcheilia
- Nasolabial cyst
- Sun poisoning
- Trumpeter's wart
|
|
|
Tongue
|
|
- Ankyloglossia
- Black hairy tongue
- Caviar tongue
- Crenated tongue
- Cunnilingus tongue
- Fissured tongue
- Foliate papillitis
- Glossitis
- Geographic tongue
- Median rhomboid glossitis
- Transient lingual papillitis
- Glossoptosis
- Hypoglossia
- Lingual thyroid
- Macroglossia
- Microglossia
- Rhabdomyoma
|
|
|
Palate
|
|
- Bednar's aphthae
- Cleft palate
- High-arched palate
- Palatal cysts of the newborn
- Inflammatory papillary hyperplasia
- Stomatitis nicotina
- Torus palatinus
|
|
|
Oral mucosa - Lining of mouth
|
|
- Amalgam tattoo
- Angina bullosa haemorrhagica
- Behçet syndrome
- Bohn's nodules
- Burning mouth syndrome
- Candidiasis
- Condyloma acuminatum
- Darier's disease
- Epulis fissuratum
- Erythema multiforme
- Erythroplakia
- Fibroma
- Focal epithelial hyperplasia
- Fordyce spots
- Hairy leukoplakia
- Hand, foot and mouth disease
- Hereditary benign intraepithelial dyskeratosis
- Herpangina
- Herpes zoster
- Intraoral dental sinus
- Leukoedema
- Leukoplakia
- Lichen planus
- Linea alba
- Lupus erythematosus
- Melanocytic nevus
- Melanocytic oral lesion
- Molluscum contagiosum
- Morsicatio buccarum
- Oral cancer
- Benign: Squamous cell papilloma
- Keratoacanthoma
- Malignant: Adenosquamous carcinoma
- Basaloid squamous carcinoma
- Mucosal melanoma
- Spindle cell carcinoma
- Squamous cell carcinoma
- Verrucous carcinoma
- Oral florid papillomatosis
- Oral melanosis
- Pemphigoid
- Pemphigus
- Plasmoacanthoma
- Stomatitis
- Aphthous
- Denture-related
- Herpetic
- Smokeless tobacco keratosis
- Submucous fibrosis
- Ulceration
- Verruca vulgaris
- Verruciform xanthoma
- White sponge nevus
|
|
|
Teeth (pulp, dentin, enamel)
|
|
- Amelogenesis imperfecta
- Ankylosis
- Anodontia
- Caries
- Concrescence
- Delayed eruption
- Dens evaginatus
- Dentin dysplasia
- Dentin hypersensitivity
- Dentinogenesis imperfecta
- Dilaceration
- Discoloration
- Ectopic enamel
- Enamel hypocalcification
- Enamel hypoplasia
- Enamel pearl
- Fluorosis
- Fusion
- Gemination
- Hyperdontia
- Hypodontia
- Maxillary lateral incisor agenesis
- Impaction
- Macrodontia
- Meth mouth
- Microdontia
- Odontogenic tumors
- Keratocystic odontogenic tumour
- Odontoma
- Open contact
- Premature eruption
- Pulp calcification
- Pulp canal obliteration
- Pulp necrosis
- Pulp polyp
- Pulpitis
- Regional odontodysplasia
- Resorption
- Shovel-shaped incisors
- Supernumerary root
- Taurodontism
- Trauma
- Avulsion
- Cracked tooth syndrome
- Vertical root fracture
- Occlusal
- Tooth loss
- Tooth wear
- Abrasion
- Abfraction
- Acid erosion
- Attrition
|
|
|
Periodontium (gingiva, Periodontal ligament, cementum, alveolus) - Gums and tooth-supporting structures
|
|
- Cementicle
- Cementoblastoma
- Cementoma
- Eruption cyst
- Epulis
- Pyogenic granuloma
- Congenital epulis
- Gingival enlargement
- Gingival cyst of the adult
- Gingival cyst of the newborn
- Gingivitis
- Desquamative
- Granulomatous
- Plasma cell
- Hereditary gingival fibromatosis
- Hypercementosis
- Hypocementosis
- Linear gingival erythema
- Necrotizing periodontal diseases
- Acute necrotizing ulcerative gingivitis
- Pericoronitis
- Peri-implantitis
- Periodontal abscess
- Periodontal trauma
- Periodontitis
- Aggressive
- As a manifestation of systemic disease
- Chronic
- Perio-endo lesion
- Teething
|
|
|
Periapaical, mandibular and maxillary hard tissues - Bones of jaws
|
|
- Agnathia
- Alveolar osteitis
- Buccal exostosis
- Cherubism
- Idiopathic osteosclerosis
- Mandibular fracture
- Microgenia
- Micrognathia
- Intraosseous cysts
- Odontogenic: periapical
- Dentigerous
- Buccal bifurcation
- Lateral periodontal
- Globulomaxillary
- Calcifying odontogenic
- Glandular odontogenic
- Non-odontogenic: Nasopalatine duct
- Median mandibular
- Median palatal
- Traumatic bone
- Osteoma
- Osteomyelitis
- Osteonecrosis
- Bisphosphonate-associated
- Neuralgia-inducing cavitational osteonecrosis
- Osteoradionecrosis
- Osteoporotic bone marrow defect
- Paget's disease of bone
- Periapical abscess
- Periapical periodontitis
- Stafne defect
- Torus mandibularis
|
|
|
Temporomandibular joints, muscles of mastication and malocclusions - Jaw joints, chewing muscles and bite abnormalities
|
|
- Bruxism
- Condylar resorption
- Mandibular dislocation
- Malocclusion
- Crossbite
- Open bite
- Overbite
- Overjet
- Prognathia
- Retrognathia
- Temporomandibular joint dysfunction
|
|
|
Salivary glands
|
|
- Benign lymphoepithelial lesion
- Ectopic salivary gland tissue
- Frey's syndrome
- HIV salivary gland disease
- Necrotizing sialometaplasia
- Mucocele
- Pneumoparotitis
- Salivary duct stricture
- Salivary gland aplasia
- Salivary gland atresia
- Salivary gland diverticulum
- Salivary gland fistula
- Salivary gland hyperplasia
- Salivary gland hypoplasia
- Salivary gland neoplasms
- Benign: Basal cell adenoma
- Canalicular adenoma
- Ductal papilloma
- Monomorphic adenoma
- Myoepithelioma
- Oncocytoma
- Papillary cystadenoma lymphomatosum
- Pleomorphic adenoma
- Sebaceous adenoma
- Malignant: Acinic cell carcinoma
- Adenocarcinoma
- Adenoid cystic carcinoma
- Carcinoma ex pleomorphic adenoma
- Lymphoma
- Mucoepidermoid carcinoma
- Sclerosing polycystic adenosis
- Sialadenitis
- Parotitis
- Chronic sclerosing sialadenitis
- Sialectasis
- Sialocele
- Sialodochitis
- Sialosis
- Sialolithiasis
- Sjögren's syndrome
|
|
|
Orofacial soft tissues - Soft tissues around the mouth
|
|
- Actinomycosis
- Angioedema
- Basal cell carcinoma
- Cutaneous sinus of dental origin
- Cystic hygroma
- Gnathophyma
- Ludwig's angina
- Macrostomia
- Melkersson–Rosenthal syndrome
- Microstomia
- Noma
- Oral Crohn's disease
- Orofacial granulomatosis
- Perioral dermatitis
- Pyostomatitis vegetans
|
|
|
Other
|
|
- Eagle syndrome
- Hemifacial hypertrophy
- Facial hemiatrophy
- Oral manifestations of systemic disease
|
|
|