Conflicting Diagnosis of a Palatal Lesion: A Case Report of Necrotizing Sialometaplasia

Necrotizing sialometaplasia (NS) is a rare condition which can be easily confused with malignancy. Its presentation initially parallels mucoepidermoid carcinoma or squamous cell carcinoma, however, NS is a benign, self-limiting inflammatory disease of the mucus-secreting minor salivary glands. NS is thought to be caused by trauma which induces vascular ischemia of these minor salivary glands. Diagnosing NS continues to be difficult, and clinical history remains one of the pillars of ruling out cancer. This report details a case of NS in a 37-year-old male who presented to the Womack Army Medical Center Oral and Maxillofacial Surgery Clinic with an exophytic mass in his right-hand palate. He had a history of recent trauma induced to the area via incision and drainage to address what was believed to be a palatal space infection. Later, an incisional biopsy was performed after the exophytic mass persisted. The initial local pathology report favored low-grade mucoepidermoid carcinoma, but after review by the Joint Pathology Center at Walter Reed Military Medical Center, the consensus diagnosis was established as NS. The patient returned to the clinic five weeks later with the exophytic mass no longer present and the biopsy site healing well.