Sir, we would like to share with your readers the case of a 46-year-old lady who presented in our A&E department. She was complaining of a large swelling in the mid-palate which had been present for one week. Prior to the swelling the patient had a short period of tooth pain originating from her upper left lateral incisor. Her medical history was all clear. She smokes 20 cigarettes a day and rinses her mouth twice a day with Listerine.

On examination there was a swelling in the palate approximately 3 cm in diameter, raised about 1 cm. The swelling was non-tender and fluctuant. There was a central area of necrosis and ulceration (Fig. 1). She is partially dentate and has carious lesions in all remaining teeth. A panoramic radiograph revealed a periapical radiolucency around UL2. Our first impression was that this was a dental abscess arising from UL2; however, when a patient presents with a palatal swelling (especially with ulceration and necrosis) salivary gland malignancy is a suspicion. Drainage was attempted but no pus discharged. An incisional biopsy was taken and antibiotics prescribed.

Figure 1
figure 1

Large swelling in the mid-palate

Full size image

Two days later the patient was reviewed and the lesion showed marked improvement, both swelling and ulceration were reduced and the swelling was draining pus. At this point the patient also mentioned that she had used an over-the-counter topical ulcer preparation containing HYBENX® on the initial swelling prior to presentation. HYBENX® is a mixture of sulphuric acid (25-35% by weight) and sulphonated phenolic acids (30-60% by weight) and it is likely that this accounts for the ulceration and necrosis by causing a chemical burn to the mucosa. Histological reports were consistent with this hypothesis.

Chemical burns from topically applied salicylic acid preparations are widely reported in the literature and can present as ulcerated or white patches on the mucosa.1,2 It is worth noting that aspirin is not the only medicament capable of producing such lesions and that some preparations designed for intraoral use can be damaging to the intraoral tissues if used incorrectly. This case highlights the importance of taking a thorough history of a presenting complaint and the need for patients to be aware of the potentially harmful effects of over-the-counter medications.