Jan - Jun 2013 / Vol. 2 Issue. 1
CLINICAL REPORT
Oral Myiasis- A Rare Case Report
Muralee Mohan MDS ' ; Amith Adyanthaya MDS*; Smitha Bhat’; Shyam S Bhat MDS‘
"Professor, Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of ental Sciences.
*Amith Adyanthaya, Reader, Department of Pedodontics, KMCT Dental College, Calicut.
Assistant Professor, Department of Oral and Maxillofacial Surgery, A B Shetty Memorial nstitute of Dental Sciences.
“Assistant Professor, Department of Oral and Maxillofacial Surgery, CIDS.
Comes
Dr. Mirae Moan
Professor, Depatment of Orland Maxillofacial Susery,
‘AB Shotly Memavial Istituto Dental Scinecs.
‘9848138787, dmuraleomobanagmaiLeom
ABSTRACT.
Received! 1305-12
Accepted 1-07-12
Oral Myiasis is a little known affliction seen only in rare neglected cases of poor oral hygiene, or in patients
with questionable mental acuity. Sucha case isbeing described, along with the treatment given,
Key Words: Myiasis; . Chrysomya bezziana; Dipteran fly larvae;
INTRODUCTION
‘The inability to maintain oral hygiene is the main
etiological factor in the development of dental
caries, periodontal disease, and other infections in
the oral cavity. A majority of handicapped children
are unable to maintain proper oral hygiene, and most
are never given professional dental care.
Individuals with disabilities deserve the same
opportunities for dental services as those who are
healthy. Various studies have been carried out to
assess the impact of mental disability on oral health
status.’ It has also been observed that the rate of
dental treatment for mentally handicapped children
is significantly less than that for normal children of
the same socio-economic status.”
‘The term Myiasis is derived from the Latin
word ‘muia’ which means fly and 'iasis’ means
disease. It is a pathology caused by the larvae in
human and animal tissue that evolve to a
parasite. The term was coined by Hope in 1840.
Myiasis was defined by Zumpt as the infestation
of live human and vertebrate animals by
dipterous larva, which at least for certain period
feed on host's dead or living tissue, liquid body
substances or ingested food.*
The most common anatomic sites for myiasis
are the nose, eye, lung, ear, anus, vagina and
more rarely, the mouth.’ Incidence of oral
myiasis as compared to that of cutaneous
myiasis is less as the oral tissues are not
permanently exposed to the external
environment.’ This condition is associated with
poor oral hygiene, alcoholism, senility,
suppurative lesions, severe halitosis, mental
retardation and other conditions.”
Arare case of oral myiasis in a mentally
handicapped boy is presented here.Jwkk,
CASE REPORT ‘The treatment plan was to eliminate all
‘A 16 year old boy accompanied by his Sources of infection from the oral cavity under
mother visited the department with the chief — general anesthesia. Intraoperatively, all teeth were
‘complaint of pain in his maxillary teeth. The mother _¢Xtracted, (Fig. 4)
gave a history of undiagnosed mental illness since
childhood but was not under any medication for the
same.
On general examination, the patient was
‘malnourished and appeared to be belonging to a
status. (Fig. 1,2)
family of poorsocio-econ
Fig. 4: Intraoperative photograph
/ and it was discovered that the anterior palatal region
was occupiedby live maggots. (Fig. 5,6)
Fig.l Fig2
Extra oral appearance General appearance
Intraoral examination revealed poor oral
hygiene, generalized periodontitis and marked
halitosis. (Fig. 3)
Fig. 6: Excavated Larvae
Fig. 3: Intraoral Appearance Oil of turpentine was applied on to that area, and
careful excavation of all the maggots was carried
The full complement of teeth was grossly out. The defect was thoroughly irrigated with saline
decayed. Maxillary anterior teeth were tender on and primary closure was achieved. The patient was
percussion, However, it was impossible to localize Put on intravenous postoperative antibiotics and
the pain since the patient was uncooperative. An analgesics. He was discharged with oral hygiene
orthopantomogram revealed generalized horizontal instructions on the 4" postoperative day. (Fig. 7)
bone loss indicating chronic generalized Hospitalstay was uneventful.
periodontitisJan - Jun 2013 / Vol. 2 Issue. 1
Fig. 7:4" Postoperative day
DISCUSSION
Oral myiasis is a rare condition and can be
caused by several species of Dipteran fly larvae and
may present secondary to serious. medical
conditions. Chrysomya hezziana is a rare myiasis-
causing fly commonly seen in south Asian counties.
‘The female adult Chrysomya bezziana fly lays 150-
200 eggs at a time on exposed wounds and mucous,
‘membranes of the mouth, ear and nose. The eggs
hatch after 24 hrs and the larvae feed on living tissue
for 5-7 days and will fall to the ground to pupate. The
pupa mature sexually in about 1 week to 2 months,
and the life cycle is completed in 2-3 months.” The
stage of larvae lasts for six to eight days during
which they are parasitic to human beings. The larvae
have backward directed segmental hooks with
which they anchor themselves to the surrounding
tissue. They are photophobic and tend to hide deep
into the tissues for a suitable niche to develop into
pupa.” Chrysomya bezziana differ from other
‘maggot infestations by its ability to cause tissue
invasion even without pre-existing necrosis. The
larvae of Chrysomya bezziana burrow deep into the
host's healthy living tissue in a screw-like fashion
feeding on living tissue that may be responsible for
the separation of palatal flap and widespread
necrosis observed in our case. Chrysomya bezziana
has also been reported as the agent causing
cutaneous myiasis, otomyiasis” and ocular
myiasis.” Oral myiasis caused by other dipterous
larvae like Oestrus ovis," Cochliomyia
hominivorax,” Muscus domesticus" and Musca
nebulo” have also been reported. The treatment
consists of topical application of turpentine oil,
mineral oil, chloroform, ethyl chloride or
‘mercuric chloride followed by manual removal
of the larvae and surgical debridement, under
sytemic antibiotic therapy."
CONCLUSION:
It is evident with the present case that it is
important to provide special attention both in basic
sanitation and medical care to those people who are
dependent on others, either due to a medically
compromised condition or a mentally/ physically
challenged status, thereby improving the quality of
life of such population.
REFERENCES
1. Al-Mutawa S, Al-Duwairi Y, Honkala E,
Honkala S, Shyama M (2002) The trends of dental
caries experience of children in Kuwait. Dent News
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2. Nunn JH, Murray JJ (1987) The dental health of
handicapped children in Newcastle and
Northumberland. BrDent J 162,9-14
3. Oral Myiasis: areport. MS Sikder, L Pradhan, F
Ferdousi et al. BIMS 2011; 10: 206-208
4, Hope FW. On insects and their larvae
occasionally found in human body. Trans R Soc
Entomol. 1840;2: 256-71
5, Zumpt F, Myiasis in man and animals in the old
world. In: Zumpt F, editors. A Textbook for
Physicians, Veterinarians and Zoologists. London:
Butterworth and Co. Ltd; 1965. p. 109.
Jen,