Necrotizing sialometaplasia – a diagnostic conundrum

Salivary gland diseases are one of the most diverse lesions encountered within the oral cavity by head and neck practitioners. With numerous differential diagnoses on board,¹ this report aims to highlight the importance of obtaining a thorough medical history and increasing awareness of the clinical presentation of necrotizing sialometaplasia to healthcare professionals. NS is a benign, inflammatory, self-healing condition often misdiagnosed as malignancy,² therefore the importance of a correct diagnosis and subsequent treatment is imperative.

This case report documents the presentation and natural history of this benign tumour-like lesion of the hard palate in a 27-year-old female with digital pictures captured from the patient's own smartphone, which show the lesion from presentation through to the healing stage.

A 27-year-old female presented to the hospital with a 5-day history of a painful swelling on the left of the midline of the hard palate, which appeared spontaneously and was intensely painful on eating. Clinical examination showed a deep necrotic ulcer with a surrounding erythematous halo measuring 2.5 cm by 2cm in diameter (Figure 1a). The cervical lymph nodes were palpable on both sides. The only relevant history included a previous diagnosis of bulimia.