Necrotising Sialometaplasia of the Palate Mimicking Malignancy: A Report of Two Cases and Review of Diagnostic Challenges

Abstract

Necrotizing sialometaplasia (NSM) is an infrequent, benign, and self-limiting inflammatory condition of the salivary glands. Owing to its close clinical and histological resemblance to malignant salivary gland tumors, it often creates significant diagnostic and therapeutic challenges. The hard palate is the most common site, although other regions containing salivary tissue may also be affected. We present two cases of palatal NSM with contrasting presentations and management approaches. In the first case, a 42-year-old man with a submucosal palatal swelling underwent surgical excision following a diagnosis of malignancy on cytology. Histopathology subsequently confirmed NSM. The second case involved a 73-year-old woman with diabetes mellitus who presented with a painful ulcer on the palate; biopsy confirmed NSM, and she was successfully managed with conservative therapy. These cases highlight the importance of recognizing NSM in the differential diagnosis of palatal lesions to prevent unnecessary aggressive interventions.