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Martwiejąca metaplazja ślinianek – łagodna choroba imitująca nowotwór złośliwy

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Martwiejąca metaplazja ślinianek jest wrzodziejącą zmianą, zwykle zlokalizowaną w tylnej części podniebienia twardego. Schorzenie może imitować nowotwór złośliwy, zarówno klinicznie, jak i histopatologicznie. Tymczasem choroba jest łagodna, samoograniczająca się i ulega samowygojeniu po około 8 tygodniach.

Martwiejąca metaplazja ślinianek jest chorobą rzadką, pojawia się nagle, a jej dokładna przyczyna nie jest znana. W piśmiennictwie medycznym przyjmuje się, choroba ma charakter niedokrwienny i jest związana z urazem lub przewlekłym drażnieniem danego miejsca. Ponadto wystąpieniu schorzenia przypisuje się inne czynniki, takie jak palenie tytoniu, spożywanie alkoholu, noszenie protez, zabieg chirurgiczny, infekcje dróg oddechowych, choroby ogólnoustrojowe, bulimia i anoreksja.

Czym charakteryzują się zmiany martwiejącej metaplazji ślinianek?

Zmiany w martwiejącej metaplazji ślinianek maja postać kraterowego owrzodzenia, o średnicy około 1-4 cm. Początkowo rana jest delikatnym obrzękiem rumieniowym. Następnie przechodzi do stadium owrzodzenia, a pokrywająca zmianę błona śluzowa ulega rozpadowi, pozostawiając głęboki, wyraźnie odgraniczony wrzód o żółtoszarej barwie. Proces martwiczy obejmuje drobne gruczoły ślinowe najczęściej na granicy między podniebieniem miękkim i twardym (zazwyczaj jednostronnie), niekiedy obejmując również język, dziąsła, wargę, jamę nosową czy duże ślinianki. Zmiany wypełnione są włóknikiem i ziarniną, towarzyszy im stan zapalny.  

Rana nie ma charakteru postępującego i ulega zamowygojeniu po około 8 tygodniach. Pacjenci niekiedy zgłaszają łagodne dolegliwości bólowe lub drętwienie. Zmiany często są jednak bezbolesne i nie wymagają specjalnego leczenia.

Jak diagnozować martwiejącą metaplazję ślinianek?

Metaplazja ślinianek uważana jest za poważny stan, ponieważ często mylona jest z nowotworem, zwłaszcza z nowotworem złośliwym ślinianek. W wyniku błędnej diagnozy u pacjentów niepotrzebnie wdrażane jest agresywne leczenie, w tym zabiegi chirurgiczne.

Rozpoznanie choroby jest trudne i opiera się na pełnym wywiadzie klinicznym. Lekarz powinien również zlecić badanie histopatologiczne zmiany. Najbardziej reprezentatywną próbkę daje pobranie wycinka z podstawy owrzodzenia oraz z najbardziej stwardniałej i uniesionej krawędzi. Połączenie wyników histopatologicznych z dogłębnym wywiadem jest najbardziej pomocne w postawieniu ostatecznej diagnozy. W przypadkach, gdy zmiana nie goi się w przeciągu 3 miesięcy, w piśmiennictwie medycznym, zalecana jest powtórna biopsja.

Źródła:

A. Gatti, E. Broccardo, G. Poglio i wsp., Necrotizing Sialometaplasia of the Hard Palate in a Patient Treated with Topical Nonsteroidal Anti-Inflammatory Drug, Case Reports in Dentistry v. 2016, str. 2-4

S. Krishna, B. K. Ramnarayan, Necrotizing sialometaplasia of palate: a case report, Imaging Sci Dent., 2011

 

Przeczytaj także: Rany jamy ustnej – dlaczego powstają i jak je leczyć?

 

 

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Częstość występowania i różnorodność patologicznych zmian w jamie ustnej u pacjentów leczonych w Zakładzie Chirurgii Stomatologicznej WUM w latach 2012–2017. Badanie retrospektywne

 

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