Oral myiasis is a rare pathology and is associated with poor oral hygiene, alcoholism, senility, suppurating lesions, and severe halitosis. It arises from invasion of body tissues or cavities of living animals by maggots or larvae of certain dipterian flies. It is mostly reported in developing countries and in the tropics. We hereby report a rare case of oral myiasis in a 70-year-old female with extensive necrotic oral lesion burrowing into the hard palate through which numerous live maggots (larvae) and seen emerging out and discuss the definition, etiology, predisposing factors, classification, and management of the same. Furthermore, the life cycle of the causative organism in the present case, that is,
Myiasis is a term derived from the Greek word “myia,” meaning invasion of vital tissue of humans or other mammals by fly larvae [
Myiasis is caused by dipterous larvae that feed on the host dead or living tissues, liquid body substances, or ingested food. Myiasis frequently occurs in rural areas, infecting livestock, and in humans prevails in unhealthy individuals in third world countries [
Incidence of oral myiasis is comparatively lesser than that of cutaneous myiasis as oral tissues are not permanently exposed to the external environment [
A 70-year-old female presented with a chief complaint of swelling in relation to the upper front teeth since 3 days. She gave history of pain which was of pricking type radiating to the upper half of the face. Extraoral examination revealed a single diffuse swelling measuring 5 × 4 cm2 involving the upper lip and the surrounding structures (Figure
Extraoral photograph revealing diffuse swelling involving the upper lip and the anterior maxilla.
Patient was from a low socioeconomic background, was malnourished, and had a poor oral hygiene. Intraoral examination revealed diffuse necrosis of soft tissues in labial vestibule in relation to teeth 11, 12, 13, 14, 21, 22, and 23. The area was soft and tender on palpation. The anterior part of the hard palate showed necrosis and the mucosa covering it was completely detached exposing the underlying bone (Figure
Intraoral photograph revealing necrosis involving labial vestibule and mucosal surface of upper lip.
Paranasal sinus view depicting radiolucency involving maxillary anterior region.
The patient was treated by removal of the maggots, debridement, and irrigation. The wound was debrided under local anesthesia and roller gauze impregnated with turpentine oil was inserted into the cavity created as a result of tissue necrosis. 30–40 live maggots were harvested from the affected region (Figure
Picture showing live maggots harvested from the affected region.
Photomicrograph showing a solitary larva of
Photomicrograph revealing spiracles typical of
Myiasis has been defined by Zumpt as “the infestation of live human and vertebrate animals with dipterous larvae which at least for a certain period feed on the host’s dead or living tissue, liquid body substance or ingested food” [
Based on substrate, myiasis is classified as (a) primary myiasis, when larvae feed on living tissue, and (b) secondary myiasis, when larvae feed on dead tissue. Depending upon the mode of infestation it is of three types: (a) accidental myiasis, when larvae get ingested along with food, (b) semispecific myiasis, when the larvae are laid on necrotic tissue of the wound, and (c) obligatory, when larvae affect undamaged skin. Based on the degree of host dependence, it is classified as (a) obligatory, where fly larvae are completely parasitic and depend upon the host for completion of their life cycle, (b) facultative, where the fly larvae are free living and only circumstantially adapt themselves to parasitic dependence to a host. Based on anatomic site, it can be classified as (a) cutaneous myiasis, (b) myiasis of external orifices, and (c) myiasis of internal organs [
Flies causing myiasis belong to the order Diptera [
The adult fly of
The development of
The treatment of myiasis comprises of local and systemic measures [
Albeit oral myiasis is an uncommon condition, is generally self-limiting, and in many cases not dangerous to the host, the clinician should be aware of this disease and should take appropriate measures for its prevention. Prevention of myiasis involves control of fly population, general cleanliness of dwelling areas, maintaining good oral and personal hygiene, and provision for basic sanitation and health education. A very intimate care needs to be taken in medically compromised dependent patients as they are unable to maintain their basic oral hygiene.
The authors declare that there is no conflict of interests regarding the publication of this paper.