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NECROTIZING SIALOMETAPLASIA
Necrotizing Sialometaplasia• Uncommon locally destructive
inflammatory condition of the salivary glands.• Cause: unknown but they believe it
is the result of ischemia of the salivary tissue that leads to local infaction.
Saliv
ary
Glan
d tis
sueISCHEMIA
OXYGEN
No blood supply
No oxygen
No ATP
No glucose
IN
FA
RC
TI
ON
ISCHEMIA AND LOCAL INFARCTION LEADING TO NECROTIZING
SIALOMETAPLASIA
Predisposing factors:
–Traumatic injuries –Dental injections–Ill fitting dentures–Upper respiratory
infections
–Adjacent tumors–Previous tumors
***However many cases occur without any known predisposing factors.
CLINICAL FEATURES
• Most frequently develops in the palatal salivary glands• Hard palate > soft palate
***2/3 of palatal cases are unilateral, with the rest being bilateral or midline in location
Unilateral
Bilateral
Midlinein location
CLINICAL FEATURES
• Has also been reported in other minor salivary gland sites and occasionally in the parotid gland.• Submandibular and sublingual
glands are rarely affected.
CLINICAL FEATURES
• Most common in adults and in men• The condition appears initially as a
non-ulcerated swelling often associated with pain or paresthesia with crater-like ulcer that can range from less than 1cm to more than 5cm in diameter appearing within 2 to 3 weeks.
CLINICAL FEATURES
HISTOPATHOLOGIC FEATURES
• Microscopic appearance of necrotizing sialometaplasia is characterized by acinar necrosis in early lesions, followed by associated squamous metaplasia of the salivary ducts.
HISTOPATHOLOGIC FEATURES
Treatment
• The lesion is self-limiting in most instances and heals uneventfully.
Xerostomia
Xerostomia
• Refers to subjective sensation of a “dry mouth”• Frequently but not always
associated with salivary gland hypofunction.
Xerostomia
CAUSES
• DEVELOPMENTAL-Salivary gland aplasia
• WATER OR METABOLITE LOSS impaired fluid intake
-impaired fluid intake-hemorrhage-vomiting or diarrhea
CAUSES
• IATROGENIC-medications
• LOCAL FACTORS-decreased mastication-smoking-mouth breathing
CAUSES
• SYSTEMIC DISEASES-Sjogren’s syndrome-diabetes mellitus-diabetes insipidus-sarcoiadosis-HIV infection-Graft-versus-host disease-psychogenic disorder