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.