Major aphthous ulcers, also known as periadenitis mucosa necrotica recurrens (PMNR) or Sutton?s disease, normally first occur after puberty. The ulcer is deeper than the one caused by the minor aphthae, its diameter is more than 10mm, prodromal pain is more intense and it can last from two weeks to several months. Fauces, lips and soft palate are commonly the affected areas. Major aphthae sometimes are accompanied by fever, malaise and dysphagia. Scarring is possibly during the healing process.