About palatal ulceration

E. Boutremans1 Mr. Shahla1, L. TANT1, R. Javadian1, N. Saint Aubain2, I. Loeb1
1Department of Oral and Maxillofacial Surgery (Dr I. Loeb), CHU Saint-Pierre, Brussels, Belgium.
2Department of Pathology (Prof. A. Verest), Institut J. Bordet, Brussels, Belgium


No patient 38 years of Polish origin is admitted for
painless ulceration evolving palate
for about 3 days. It is situated on both sides of the
center line and outlines the jawbone deep.
This patient also smoking does no other antecedent
particular. The systematic examination reveals
or taking cocaine or local injection of vasoconstrictor
or other caustic may explain the presence of
this ulceration. The rest of the oral cavity is free of
other injury.
A Current Biology reveals an inflammatory syndrome
(CRP 14.2 mg / L). A CT scan of the facial reveals
or bone disease or naso-oral communication. We
towards a diagnosis of granulomatous inflammatory lesion
or infectious.
A smear of the lesion and a biopsy specimen are made.
Pending results, the patient is placed on antibiotics
preventive (Augmentin  4x1gr IV) and local care based
eosin  aqueous 2%.
Faced with this type of injury following differential diagnoses must
be mentioned:
1. Ulceration traumatic, iatrogenic (SIB injury
by object, injection vasoconstrictor drugs ...).
2. Neoplasia:
a. salivary adenocarcinoma: adenoid cystic carcinoma,
mucoepidermoid carcinoma, adenocarcinoma acinar cells,
polymorphic well-differentiated adenocarcinoma, tumor
malignant mixed;
b. Lymphoma;
c. Sarcomas;
d. Metastatic lesion.
3. Chronic inflammatory disorders:
a. Périadénite Sutton;
b. Sialométaplasie necrotizing
c. Erosive lichen planus;
d. Discoid lupus erythematosus;
e. Lichenoid reaction or lupus.
4. Chronic infections:
a. Tuberculosis;
b. Or tertiary syphilis;
c. Mycosis.
5. Vasculitis: Wegener's granulomatosis.
Serologies performed to search for syphilis and herpes
were negative. Under treatment, the lesion has involuted,
the bottom of the ulcer is filled in 10 days, two-thirds,
by granulation tissue.