Subacute necrotizing sialadenitis: a form of necrotizing sialometaplasia?

OBJECTIVES To report our experience of subacute necrotizing sialadenitis (SANS), an unusual lesion of the minor salivary palatal glands, and to discuss its relationship with necrotizing sialometaplasia (NS). DESIGN A retrospective review of records for patients with SANS identified between 1996 and 2001. SETTING Academic center, referral center, and an ambulatory care center. PATIENTS Three patients (1 woman, 2 men), aged 22, 23, and 40 years at diagnosis. INTERVENTION All 3 patients underwent incisional biopsy. MAIN OUTCOME MEASURES Clinical description of SANS, ability to make the diagnosis preoperatively, clinical evolution, histologic features, and comparison with the much more frequent NS. RESULTS Three patients presented with a lateral palatal nodule (1 case bilateral, 1 case ulcerated) of 7 to 10 days' duration, 0.8 to 1.0 cm in size, slightly or not painful. No patient was correctly diagnosed prior to undergoing a biopsy. In all 3 cases, the biopsy specimen showed acinic necrosis surrounded by a dense polymorphous inflammatory infiltrate with atrophy of ductal cells but no squamous metaplasia. Healing occurred without any further treatment in up to 3 weeks. No recurrence was observed in 2 cases; 1 patient was lost to follow-up. CONCLUSIONS SANS is a painful spontaneously resolving necrosis of the palatal salivary glands, easily misdiagnosed preoperatively. The main differences from NS are smaller size of lesion, scarcity of ulceration, and absence of squamous metaplasia. Although initially described as a new autonomous entity, SANS might be an early or minimal form of NS.