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

Case Report

Oral Myiasis: A case

Suhas Godhi, Sonia Goyal, Manish
Pandit
Department of Oral and Maxillofacial
Surgery, I.T.S Centre for Dental Studies

report and Research

Address for Correspondence:

Suhas Godhi
Professor & Head
Dept. of OMFS, I.T.S Centre for Dental
Suhas Godhi, Sonia Goyal, Manish Pandit Studies and Research
Abstract: Oral myiasis is a rare condition caused by invasion of living tissue by Delhi-Meerut Road, Muradnagar
larvae of the flies. A 25 year old female patient presented with a case of oral myiasis. Ghaziabad, Uttarpradesh
Ph : 09899450488
She had massive swelling of the upper lip. The lesion was treated with topical
E-mail: drgodhi@yahoo.com
application of turpentine liniment followed by mechanical removal of larvae. Follow-
up examination revealed complete subsidence and healing of the lesion. Received for publication April 2008
Accepted after peer review June 2008
Keywords: Myiasis, flies and fly larvae. Available online June 2008 at www.jmosi.com

Introduction
Myiasis refers to the invasion of living
tissues by fly larvae. 1 The term Myiasis is
derived from the Greek word myia meaning
fly. It was coined by Hope in 1840. It was
defined by Zumpt as the infestation of live
human and vertebrate animals with
dipterous larvae, which, atleast for a certain
period feed on the host’s dead or living
tissue, liquid body substance or ingested
food.1,2,3,4
Oral Myiasis was first described by
Laurance in 1909.3 It has been reported
mainly in the developing countries such as
Asia and very rarely in the western
developed countries.12
Myiasis can be classified depending
Fig. 1: Pre operative extra oral view of the Fig.2: Pre operative intra oral view of the
upon the condition3 of the involved tissue
patient patient
into 3:
1) Accidental Myiasis: Larvae is ingested the necrobiphagous flies (feed on dead Case report
along with food producing infection. tissue). This is a more common type and A 25 year old female patient reported
2) Semi specific Myiasis: The larvae are attacks patients with necrotic cavity to the Department of Oral and Maxillofacial
laid on necrotic tissue in wounds. lesions. Surgery at I.T.S Centre for Dental Studies
3) Obligatory Myiasis: Larvae affect The flies lay over 500 eggs at a time and Research, Muradnagar, Ghaziabad, UP
undamaged skin. directly over the diseased tissue. The eggs with a history of trauma to the upper lip
Based on the anatomic site affected, hatch in less than one week and the life before one month. She was poor and
Myiasis is subdivided into a) Cutaneous cycle is completed within two weeks. The appeared malnourished. She was unable to
Myiasis, b) Myiasis of external orifice larvae obtain their nutrition from the close her mouth completely. On general
aural, ocular, nasal, oral, vaginal and anal, surrounding tissues and burrow deeper into clinical examination the patient was
c) Myiasis of internal orifice: intestinal and the soft tissues by making tunnels, disoriented and uncooperative. Local
urinary. separating the gingival and examination revealed massive swelling of
Clinically Myiasis can be classified as mucoperiosteum from the bone. 5 the upper lip (Fig. 1).
primary and secondary3: Some cases described in the literature Examination of the oral cavity revealed
Primary Myiasis is caused by were secondary to medical or anatomical poor oral hygiene, halitosis and mobility
biphagous larvae (feed on living tissue) conditions such as Cancrum oris,6 cerebral of the maxillary right central incisor, left
which are common in cattle and rare in palsy, 7,8 Epilepsy, 9 mouth breathing, central incisor and left lateral incisor teeth.
humans. fracture, anterior open bite and incompetent Slight retraction of the upper lip exposed a
Secondary Myiasis is that caused by lips.10 large number of black tipped larvae in the
Journal of Maxillofacial & Oral Surgery 2008 Vol. 7 : No. 2
Fig.3: CT scan of the maxilla
Fig.6: Post operative intra oral view of the
patient
open wound (Fig. 2). The larvae were
present on the palatal mucosa also. The
wound involved the labial mucosa, the
labial and buccal sulcus and was extending
towards canine space also. Right maxillary
cortical plate was exposed and covered with
necrotic mucosa. The CT scan revealed no
bony involvement (Fig. 3). Hematological
analysis revealed neutrophilia and raised
ESR.
The patient was hospitalized and
intravenous infusion was given, as oral
intake was not possible. She was put on
third generation Cephalosporin 1gm twice
a day in addition to Metrogyl infusion
100ml twice a day for 5 days.
The wound of the lip and palate was
thoroughly flushed with normal saline
followed by the topical application of the
turpentine liniment for 15- 20 min. The
large numbers of larvae were removed by
blunt tweezers (Figs. 4, 5).
Exploration of wound revealed
multiple burrows and tunnels within the
upper lip and palatal mucosa and large
number of larvae, which were removed. The
mobile maxillary anterior teeth were
extracted.
The same procedure was continued for
seven consecutive days until no larvae were
found in the tissue. The cleaning of wound
with normal saline and betadine was carried
out daily until the wound healed (Fig. 6).
Fig.4: Collected larvae
Fig.7: Post operative extra oral view of the
patient
Post operative healing was uneventful
(Fig. 7).
The larvae recovered from the wound
were preserved in 40% formaldehyde and
were identified as a larvae of Musca
Domesticus.
Discussion
Myiasis is an uncommon disease in
humans and takes many forms including
infection of skin, gut, nasal cavities, and
eyes11 and occasionally the oral cavity.12
Myiasis occurs in people who live close to
livestocks. It occurs more commonly in
rural areas than in urban.4 The risk factors
for the development of oral Myiasis are
suppurative lesions, facial trauma and poor
oral hygiene.
Myiasis is caused by members of the
Diptera fly family, that lay eggs or larvae
on food, necrotic tissue, open wounds, and
unbroken skin or mucosa. 13 Mechanical
removal of larvae is the traditional
treatment for Myiasis, but the use of
systemic Ivermectin can give favorable
results in some cases.14 Local application
of iodoform, ethyl chloride, mercuric
chloride, creosote, saline, turpentine oil or
systemic butazolidine and thiobendazole
has also been used.
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