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Diagnosis of NS Histopathologic diagnosis and a complete clinical history

Clinical presentation of NS Painful, rapidly progressing swelling of the hard palate with central ulceration and peripheral erythema Numbness or anesthesia as an early finding Rapid onset, range in size from 1 to 3 cm Predominantly on the palate, usually unilateral Resemble salivary gland malignancies, occur shortly after an inciting event

Factors associated with NS Smoking Local injury Blunt force trauma Denture wear Surgical procedures Local ischemic event Infectious process Immune response to an unknown allergen Pregnancy Diabetes mellitus Sickle-cell disease Cocaine abuse Bulimia Chronic vomiting

Necrotizing sialometaplasia (NS) Benign, self-limiting, reactive inflammatory disorder of salivary tissue

Postsurgical complications of ranula treatment include lesion recurrence, sensory deficits of the tongue, and damage to Wharton's duct

Treatment of ranula 1. Sublingual gland adenectomy combined with intraoral excision 2. Marsupialization, injection of sclerosing agent (silver nitrate)

Diagnosis of ranula Clinical appearance, ultrasound to rule out other cystic lesions

Clinical presentation of ranula Painless, slow-growing, fluctuant, movable mass located in the floor of the mouth Usually one side of the lingual frenulum, may extend deep and cross the midline Superficial lesion has bluish hue, deeply located has normal mucosa Larger lesions cause deviation of the tongue

Possible causes of ranula Mechanical trauma to its ducts of Rivinus Obstructed salivary duct or a ductal aneurysm

Ranula Located in the floor of the mouth, arise from the sublingual gland due to continuous salivary secretion

Treatment of mucoceles 1. Surgical removal of the entire mucocele 2. Incomplete removal leads to recurrence 3. Alternative treatments include electrosurgery, cryosurgery, laser surgery, intralesional injections of corticosteroids, and sclerotherapy

Mucoceles Discrete, painless, smooth-surfaced swellings that can range from a few millimeters to a few centimeters in diameter Superficial lesions have blue hue, frequently traumatized, drain and recur Deeper lesions covered by normal mucosa without blue color

Retention type mucocele Caused by obstruction of a minor salivary gland duct often by sialolith, periductal scaring, or tumor

Extravasation mucocele Does not have an epithelial lining or a distinct border, results from trauma to a minor salivary gland excretory duct

Treatment of sialolithiasis 1. Supportive analgesics, hydration, antibiotics, and antipyretics 2. Use Sialogogues (chewing gum, pilocarpine, and cevimeline) 3. Massage and heat 4. Milking the gland for stones at or near the orifice of the duct 5. Conventional surgery or sialendoscopy for deeper stones 6. Extracorporeal shock wave lithotripsy (ESWL) for fragmentation of large sialoliths

Ultrasound can visualize radiolucent calculi

Contrast sialography is contraindicated in acute sialadenitis

Contrast sialography can aid in differentiating sialoliths from calcified phleboliths

Small and poorly calcified stones may not be readily identifiable

Diagnosis of parotid sialolithiasis AP view of the face or an occlusal film placed intraorally adjacent to the duct