Oral Myiasis-A Case Report

292 Journal of Maxillofacial & Oral Surgery 2008 Vol. 7 : No. 2

Case Report

Suhas Godhi, Sonia Goyal, ManishPanditDepartment of Oral and MaxillofacialSurgery, I.T.S Centre for Dental Studiesand Research

Address for Correspondence:

Suhas GodhiProfessor & HeadDept. of OMFS, I.T.S Centre for DentalStudies and ResearchDelhi-Meerut Road, MuradnagarGhaziabad, UttarpradeshPh : 09899450488E-mail: drgodhi@yahoo.com

Received for publication April 2008Accepted after peer review June 2008

Available online June 2008 at www.jmosi.com

Oral Myiasis: A casereportSuhas Godhi, Sonia Goyal, Manish Pandit

Abstract: Oral myiasis is a rare condition caused by invasion of living tissue bylarvae of the flies. A 25 year old female patient presented with a case of oral myiasis.She had massive swelling of the upper lip. The lesion was treated with topicalapplication of turpentine liniment followed by mechanical removal of larvae. Follow-up examination revealed complete subsidence and healing of the lesion.

Keywords: Myiasis, flies and fly larvae.

Fig.2: Pre operative intra oral view of thepatient

Fig. 1: Pre operative extra oral view of thepatient

IntroductionMyiasis refers to the invasion of living

tissues by fly larvae.1 The term Myiasis isderived from the Greek word myia meaningfly. It was coined by Hope in 1840. It wasdefined by Zumpt as the infestation of livehuman and vertebrate animals withdipterous larvae, which, atleast for a certainperiod feed on the host’s dead or livingtissue, liquid body substance or ingestedfood.1,2,3,4

Oral Myiasis was first described byLaurance in 1909.3 It has been reportedmainly in the developing countries such asAsia and very rarely in the westerndeveloped countries.12

Myiasis can be classified dependingupon the condition3 of the involved tissueinto 3:1) Accidental Myiasis: Larvae is ingested

along with food producing infection.2) Semi specific Myiasis: The larvae are

laid on necrotic tissue in wounds.3) Obligatory Myiasis: Larvae affect

undamaged skin.Based on the anatomic site affected,

Myiasis is subdivided into a) CutaneousMyiasis, b) Myiasis of external orificeaural, ocular, nasal, oral, vaginal and anal,c) Myiasis of internal orifice: intestinal andurinary.

Clinically Myiasis can be classified asprimary and secondary3:

Primary Myiasis is caused bybiphagous larvae (feed on living tissue)which are common in cattle and rare inhumans.

Secondary Myiasis is that caused by

the necrobiphagous flies (feed on deadtissue). This is a more common type andattacks patients with necrotic cavitylesions.

The flies lay over 500 eggs at a timedirectly over the diseased tissue. The eggshatch in less than one week and the lifecycle is completed within two weeks. Thelarvae obtain their nutrition from thesurrounding tissues and burrow deeper intothe soft tissues by making tunnels,separating the gingival andmucoperiosteum from the bone.5

Some cases described in the literaturewere secondary to medical or anatomicalconditions such as Cancrum oris,6 cerebralpalsy,7,8 Epilepsy,9 mouth breathing,fracture, anterior open bite and incompetentlips.10

Case reportA 25 year old female patient reported

to the Department of Oral and MaxillofacialSurgery at I.T.S Centre for Dental Studiesand Research, Muradnagar, Ghaziabad, UPwith a history of trauma to the upper lipbefore one month. She was poor andappeared malnourished. She was unable toclose her mouth completely. On generalclinical examination the patient wasdisoriented and uncooperative. Localexamination revealed massive swelling ofthe upper lip (Fig. 1).

Examination of the oral cavity revealedpoor oral hygiene, halitosis and mobilityof the maxillary right central incisor, leftcentral incisor and left lateral incisor teeth.Slight retraction of the upper lip exposed alarge number of black tipped larvae in the

293Journal of Maxillofacial & Oral Surgery 2008 Vol. 7 : No. 2

Fig.3: CT scan of the maxilla Fig.4: Collected larvae Fig.5: close-up view of larvae

Fig.6: Post operative intra oral view of thepatient

Fig.7: Post operative extra oral view of thepatient

open wound (Fig. 2). The larvae werepresent on the palatal mucosa also. Thewound involved the labial mucosa, thelabial and buccal sulcus and was extendingtowards canine space also. Right maxillarycortical plate was exposed and covered withnecrotic mucosa. The CT scan revealed nobony involvement (Fig. 3). Hematologicalanalysis revealed neutrophilia and raisedESR.

The patient was hospitalized andintravenous infusion was given, as oralintake was not possible. She was put onthird generation Cephalosporin 1gm twicea day in addition to Metrogyl infusion100ml twice a day for 5 days.

The wound of the lip and palate wasthoroughly flushed with normal salinefollowed by the topical application of theturpentine liniment for 15- 20 min. Thelarge numbers of larvae were removed byblunt tweezers (Figs. 4, 5).

Exploration of wound revealedmultiple burrows and tunnels within theupper lip and palatal mucosa and largenumber of larvae, which were removed. Themobile maxillary anterior teeth wereextracted.

The same procedure was continued forseven consecutive days until no larvae werefound in the tissue. The cleaning of woundwith normal saline and betadine was carriedout daily until the wound healed (Fig. 6).

Post operative healing was uneventful(Fig. 7).

The larvae recovered from the woundwere preserved in 40% formaldehyde andwere identified as a larvae of MuscaDomesticus.

DiscussionMyiasis is an uncommon disease in

humans and takes many forms includinginfection of skin, gut, nasal cavities, andeyes11 and occasionally the oral cavity.12

Myiasis occurs in people who live close tolivestocks. It occurs more commonly inrural areas than in urban.4 The risk factorsfor the development of oral Myiasis aresuppurative lesions, facial trauma and poororal hygiene.

Myiasis is caused by members of theDiptera fly family, that lay eggs or larvaeon food, necrotic tissue, open wounds, andunbroken skin or mucosa.13 Mechanicalremoval of larvae is the traditionaltreatment for Myiasis, but the use ofsystemic Ivermectin can give favorableresults in some cases.14 Local applicationof iodoform, ethyl chloride, mercuricchloride, creosote, saline, turpentine oil orsystemic butazolidine and thiobendazolehas also been used.

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