An " oiot 88:1979 NECROTIZING SIALOMETAPLASIA OF THE NASOPHARYNX

Necrotizing sialometaplasia is an uncommon salivary gland disease originally described by Abrams et al in 1973. The disease may occur wherever salivary gland tissue is found. Theories on the etiology of this disorder have been advanced, but never definitely determined. Treatment consists of adequate biopsy and observation until healing occurs at six to eight weeks. While the disease is considered benign, its similarity to more aggressive neoplasms can be both dis-turbing and misleading to the patient and the clinician. Such a case of necrotizing sialometa-plasia of the nasopharynx is presented to demonstrate the clinical and histological similarity of this disease to carcinoma. In this case, the patient first presented with a neck mass which could easily have been mistaken for a regional metastasis. The current literature is reviewed. Since the description by Abrams et all of necrotizing sialometaplasia of the salivary glands, a total of 35 individual cases have been cited in the literature, including the case to be reported here."> There is need for great care in the diagnosis of ulcerating lesions of the hard and soft palate as necrotizing sialo-metaplasia can easily be confused clini-cally and histopathologically with both mucoepidermoid carcinoma and squa-mous cell carcinoma. The diagnosis of carcinoma dictates aggressive surgical or radiotherapeutic treatment and car-ries with it psychological and socioeco-nomic implications which are inappro-priate to a diagnosis of a benign condi-tion. Adequate tissue must be obtained at biopsy in order to differentiate this disease from the malignant neoplasms. Having diagnosed necrotizing sialometa-plasia, the treatment of choice is close observation with continued follow-up until the lesion has healed in six to eight weeks. Early reports on necrotizing sialo-metaplasia suggested that the disease process is limited to the hard palate; subsequent reports have placed lesions in the soft palate, " retromolar trigone," nose and nasopharynx, " and major saliv-ary glands. ' A case of necrotizing sialo-metaplasia occurring on the nasopha-ryngeal aspect of the soft palate at the base of the uvula is presented. The lesion had the gross appearance of a mucocele when first seen and eventually pro-gressed to a slough of the entire uvula