Necrotising sialometaplasia

Necrotising sialometaplasia is a benign inflammatory condition of the salivary gland remnants or elements, which is usually self-limiting.  It is most commonly found on the palate

Most patients are more than 40 years of age, with a male: female ratio of 2:1. It is rarely seen in children. The palate is the most common site involved, usually located in the back of the hard palate.

Starts as non-ulcerated swelling with pain. In 2-3 weeks, the necrotic tissue leads to ulcer(s). The condition is usually self-limiting and shows complete remission subsequently without treatment within 6 to 10 weeks. 

Uncertain, possibly secondary to ischaemia of the salivary tissue leading to infarction. Other postulated causes include:

  • abnormal dentures causing chronic irritation to the palate
  • following adenoidectomy in children
  • prior surgery
  • local trauma
  • dental injections
  • alcohol abuse
  • smoking
  • cocaine use
  • upper respiratory infections
  • radiation
  • adjacent tumour growths
  • bulimia

Acinar necrosis is found in early lesions. Subsequently, concomitant squamous metaplasia is seen. Despite necrosis, the lobular architecture of the glands is preserved. Metaplasia may mimic a malignant lesion, hence recognition of this condition is paramount.

Five histological stages have been described: infarction, sequestration, ulceration, reparation and healing.

Despite squamous metaplasia, malignant transformation is very rare.

Soft tissue density swelling of the palate which may show ulceration

They are seen as lobulated submucosal palatal lesions

  • T1: hypointense
  • T2: hyperintense
  • T1 C+: thin peripheral enhancement

Possible differential considerations include

  • mucoepidermoid carcinoma
  • squamous cell carcinoma
  • granulomatous diseases (syphilitic gumma) 
  • fungal infections
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Article information

rID: 50872
System: Head & Neck
Synonyms or Alternate Spellings:
  • Necrotizing sialometaplasia

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