Also called periadenitis mucosa necrotica recurrens or Sutton’s disease (alo Mikulicz’s scarring aphthae).  It starts with a reddish nodule that due to necrosis becomes a bigger and deeper ulcer than the normal aphthous lesion.  Various lesions may appear, and are very painful and slow to heal.  The recurrence of lesions is disturbing to the patient, forces a change in feeding habits, and causes sialorrhea and halitosis.  It is characterized by leaving fibrous scars.  Etiology is similar to that of normal aphthae.

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