Clinicopathologic Conference| Volume 134, ISSUE 2, P120-123, August 2022

Necrotic lesion in the palate

Published:October 01, 2021DOI:
      A 38-year-old female patient was referred to our department of oral pathology with a chief complaint of a painless and nonhealing “hole in her palate” with an evolution time of 30 days. Clinical examination revealed an area of necrosis affecting the left posterior region of the hard palate (Figure 1), and imaging examinations demonstrated no sign of oronasal communication. No palpable cervical lymph node was found. The patient reported a 3-year history of cigarette smoking, approximately 40 cigarettes per day, and she presented with a nonproductive cough lasting for 6 months, considered a complication of the smoking habit. No other relevant medical history that could have influenced the development of necrosis in the region, such as radiotherapy treatment or use of bisphosphonates, was reported.
      Fig 1
      Fig. 1Initial appearance of the oral injury, presenting clinically as a necrotic ulcer.
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        • Ledesma-Montes C
        • Garcés-Ortíz M
        • Salcido-García JF
        • Hernández-Flores F.
        Review of the literature on necrotizing sialometaplasia and case presentation.
        Quintessence Int. 2015; 46: 67-72
        • Kaplan I
        • Alterman M
        • Kleinman S
        • et al.
        The clinical, histologic, and treatment spectrum in necrotizing sialometaplasia.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114: 577-585
        • Nobre MA
        • Gomes J
        • Maia P
        • Salvado F.
        Necrotizing sialometaplasia and bulimia: a case report.
        Medicina (Kaunas). 2020; 56: 188
        • Wu YH
        • Kuo YS
        • Lin PY
        • Chiang CP.
        Necrotizing sialometaplasia - case report.
        J Dent Sci. 2020; 15: 390-392
        • Pontes HAR
        • Pontes FSC
        • Silva BSF
        • et al.
        Extranodal nasal NK/T-cell lymphoma: a rare oral presentation and FASN, CD44 and GLUT-1 expression.
        Braz Dent J. 2013; 24: 284-288
        • Andreou A
        • Thermos G
        • Sklavounou-Andrikopoulou A.
        Extranodal NK/T cell lymphoma, nasal type with palatal involvement: a rare case report and literature review.
        Head Neck Pathol. 2021; 15: 621-627
        • Mariz BALA
        • Feio PSQ
        • Roza ALOC
        • et al.
        Clinical predictors of malignancy in palatal salivary gland tumors.
        Oral Dis. 2019; 25: 1919-1924
        • Vaidya AD
        • Pantvaidya GH
        • Metgudmath R
        • Kane SV
        • D'Cruz AK
        Minor salivary gland tumors of the oral cavity: a case series with review of literature.
        J Cancer Res Ther. 2012; 8 Suppl 1: S111-S115
        • McKinney R
        • Olmo H.
        Physical and chemical lesions of the oral mucosa.
        StatPearls. StatPearls Publishing, Treasure Island, FLMay 21, 2021
        • Gilvetti C
        • Porter SR
        • Fedele S.
        Traumatic chemical oral ulceration: a case report and review of the literature.
        Br Dent J. 2010; 208: 297-300
        • Guimarães DM
        • Nascimento LS
        • Pedrinha VF
        • et al.
        Avascular necrosis of the jaws as initial presentation of acute leucemia.
        Quintessence Int. 2016; 47: 791-797
        • Cloarec N
        • Zaegel-Faucher O
        • Bregigeon S
        • et al.
        Mandibular osteonecrosis and dental exfoliation after trigeminal zoster in an HIV-infected patient: case report and review of the literature.
        AIDS. 2014; 28: 448-450
        • Naik NH
        • Russo TA.
        Bisphosphonate-related osteonecrosis of the jaw: the role of actinomyces.
        Clin Infect Dis. 2009; 49: 1729
        • Morse CG
        • Dodd LE
        • Nghiem K
        • et al.
        Elevations in D-dimer and C-reactive protein are associated with the development of osteonecrosis of the hip in HIV-infected adults.
        AIDS. 2013; 27: 591-595
        • Drake LR
        • Scott PJH.
        Dark classics in chemical neuroscience: cocaine.
        ACS Chem Neurosci. 2018; 10: 2358-2372
        • Center for Behavioral Health Statistics and Quality
        • Substance Abuse and Mental Health Services Administration
        2014 National survey on drug use and health.
        Substance Abuse and Mental Health Services Administration, Rockville, MD2015
        • United Nations Office on Drugs and Crime
        Annual prevalence of use of drugs in 2017.
        Division for Policy Analysis and Public Affairs, United Nations Office on Drugs and Crime, Vienna, Austria2019
        • Organization for Economic Cooperation and Development (OECD)
        Addressing problematic opioid use in OECD countries.
        OECD Publishing, Paris, France2019
        • Bhargava S
        • Arora RR.
        Cocaine and cardiovascular complications.
        Am J Ther. 2011; 18: e95-e100
        • Silvestre FJ
        • Perez-Herbera A
        • Puente-Sandoval A
        • Bagán JV.
        Hard palate perforation in cocaine abusers: a systematic review.
        Clin Oral Investig. 2010; 14: 621-628
        • Oliveira MGA
        • Santos JN
        • Cury PR
        • et al.
        Cytogenetic biomonitoring of oral mucosa cells of crack cocaine users.
        Environ Sci Pollut Res Int. 2014; 21: 5760-5764
        • Antoniazzi RP
        • Lago FB
        • Jardim LC
        • Sagrillo MR
        • Ferrazzo KL
        • Feldens CA.
        Impact of crack cocaine use on the occurrence of oral lesions and micronuclei.
        Int J Oral Maxillofac Surg. 2018; 47: 888-895
        • Brand HS
        • Gonggrijp S
        • Blanksma CJ.
        Cocaine and oral health.
        Br Dent J. 2008; 204: 365-369
        • Mitchell-Lewis DA
        • Phelan JA
        • Kelly RB
        • Bradley JJ
        • Lamster IB
        Identifying oral lesions associated with oral cocaine use.
        J Am Dent Assoc. 1994; 125: 1104-1108
        • Di Cosola M
        • Turco M
        • Acero J
        • Navarro-Vila C
        • Cortelazzi R.
        Cocaine related syndrome and palatal reconstruction: report of a series of cases.
        Int J Oral Maxillofac Surg. 2007; 36: 721-727