DISCUSSION:
As the title says, this is the self-limiting condition, and in our patient the lesion healed within a span of 15 days. This posed us a diagnostic dilemma, since the patient was young, presented with the rapid onset of the ulceration with the positive history of exposure to carcinogenic products, was initially diagnosed as malignant ulcer. as a part of an investigation, an incisional biopsy was done which was surprisingly Necrotizing sialometaplasia. This condition would have been considered as a differential diagnosis due to following factors such as typical location of its occurrence in the hard palate, gender of the patient and smoking being one of the predisposing factor. However, we missed out this lesion in the initial diagnosis probably because of its rarity, and not so prevalent in our country Nepal. This lesion was challenging for us during histopathological slide analysis since most of the features mimicked a malignancy. The careful examination of the histopathological features by an experienced pathologist led us to the correct diagnosis. Prior knowledge of the lesion and its features is very important to every clinician and every oral physician and oral pathologist so that misdiagnosis does not occur. After going through the literature based on this lesion, most of the case reports has reported this lesion in palatal region, and very rarely in other location. The typical characteristics of this lesion is presence of an ulceration with slough. Smoking can be considered as a probable etiological factor in this case since this is considered one among the etiology. However exact etiopathogenesis of how smoking causes necrotizing sialometaplasia has not yet been studied. Patient was subjected to routine laboratory investigation to rule out other conditions. Histopathological analysis using H&E staining is still considered as a gold standard, similarly done in our case. However, Rizkalla et al in his study used immunohistochemistry for identification of myoepithelial cells and CK7 expression which may help to distinguish NSM from its mimics.13 this lesion usually does not require any specific treatment, however symptomatic and conservative management is required.