Sialometaplasia necrotizing K11.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Necrotizing sialometaplasia; sialometaplasia

History
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Abrams et al., 1973

Definition
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Sudden, painful, sharply defined ulcer formation in the area of the A. palatina maior (usually at the transition from hard to soft palate).

Etiopathogenesis
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Thrombosis of a palatal artery with creeping necrosis of submucous salivary glands and consecutive necrosis of the surface epithelium. This can be caused by prosthesis pressure, drug-induced vasospasms (e.g. after ganglion stellatum blockage) or system vasculitis ( endangiitis obliterans). Occurrence is more frequent in smokers.

Manifestation
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Occurring in middle age (40-50 years).

Localization
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The oral mucosa (central location) and especially the transition from hard to soft palate are affected.

Clinical features
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Sudden, pulling pain in the area of the central palate (typically at the transition from soft to hard palate). After a few days, circumscribed erythema followed by sharply defined, initially flat, later possibly also deep, widely punched ulcer formation. Healing within a few weeks leaving a scar.

Histology
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Granulation tissue with lobular aggregated (regenerative) squamous epithelial nests and remnants of mucous salivary glands. Histologically, there is a risk of misdiagnosis as squamous cell carcinoma due to regenerative squamous cell metaplasia, which is probably caused by the slow onset of necrosis of the surface epithelium.

Differential diagnosis
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Complication(s)
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Rare are accompanying paresthesias of the face and intermittent visual disturbances.

Literature
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  1. Abrams AM, Melrose RJ, Howell FV (1973) Necrotizing sialometaplasia. A disease simulating malignancy. Cancer 32: 130-135
  2. Flint SR (2005) Necrotizing sialometaplasia: an important diagnosis--review of the literature and spectrum of clinical presentation. J Ir Dent Assoc 51: 26-28
  3. Keogh PV et al (2004) Necrotizing sialometaplasia: an unusual bilateral presentation associated with antecedent anaesthesia and lack of response to intralesional steroids. Case report and review of the literature. Br Dent J 196: 79-81
  4. Schmidt-Westhausen A et al (1991) Necrotizing sialometaplasia of the palate. Literature report of 3 new cases. German Z Mouth Jaw Face Shield 15: 30-34
  5. Voigtländer C et al (2007) Ulceration on the hard palate of a 50-year-old patient. dermatologist 58: 161-162
  6. Zschoch H (1992) Mucus gland infarct with squamous epithelial metaplasia in the lung. A rare site of so-called necrotizing sialometaplasia. Pathologist 13: 45-48

Incoming links (1)

Thrombangiitis obliterans;

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Last updated on: 29.10.2020