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1. INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
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2. Case report
Complaint of massive, painful
swelling of upper left cheek &
involving the eye.
Undergone uneventful
extraction of upper left back
teeth 5 days back.
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3. Past history
 Known diabetic & hypertensive since 10 years.
 Not under regular medication ( uncontrolled diabetic)
 Suffered from mucormycosis of left nasal cavity &
maxillary sinus 1 ½ years back
 Had undergone lateral rhinotomy medial
maxillectomy & debridement .
 Social history low socioeconomic background
residing in rural area.
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4. Clinical examination
 General examination
 Vital signs - 150/90,
103o
F
 Extra oral examination –
swelling of left cheek &
eye.
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5. Intra oral examination
 Non healing extraction site
24,25
 Poor oral hygiene
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6.  Irrigation of extraction
site revealed maggots
 8-10 maggots removed
from communication
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7. Diagnosis
 Myiasis
 PNS view taken to see the status of
bone
 Hematological examination
revealed RBS of 250mg /dl.
 ELISA : -ve
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8. Treatment received
 Inj. Cefotaxim (Taxim) 1gm IV TID x 7 days
 Inj. Metronidazole (Metro) 100ml IV TID x 7 days
 Inj. Diclofenac sodium (Diclo) 1 amp IM x 5 days
 Inj. Ranitidine (Rantac) 1 amp IV x 5 days
 Inj. Insulin (H. Mixtard) 14-0-10 x 7 days
 Inj. Insulin (H. Actrapid) 0-4-0 x 5 days
 Cotton soaked in turpentine oil was placed in the
communication & repeated for 4 days.
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9. After 1st
week ( at discharge )
 Inj. Insulin (H. Mixtard) 15 -0-10
 T. Enalapril (Envas) 5mg 1-0-1
 T. Amoxicillin (Mox LB) 1-1-1 x 5
days
 T. Diclofenac sodium (Diclo) 50mg
1-0-1 x 5 days
 T. Ranitidine (Rantac) 150mg 1-0-1
x 5 days
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10. After 1 month
 Failure of patient to report after
a week for review
 After one month – c/o difficulty in
eating, regurgitation of fluids, &
halitosis
 O/E – necrotic left maxillary
bone
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11. Left maxillectomy
Postoperative healing uneventful over 4 months follow upwww.indiandentalacademy.com

12. Before treatment After treatment
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13. Discussion
 Myiasis refers to invasion of living tissues by fly larvae .
 Derived from Greek word ‘myia meaning fly’.
 First coined by F.W.Hope in 1840 .
 Zumpt defined as the infestation of live human & 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.
 Oral myiasis first described by Laurance in 1909.
Godhi.S et al. Oral myiasis.Journal of maxillofacial & oral surgery 2008;7:292-93.www.indiandentalacademy.com

14.  Common in rural areas
 Risk factors – poor oral hygiene, suppurative lesions, trauma.
 Reported cases of myiasis secondary to medical conditions.
 Causative agent – members of diptera fly family
 Lay eggs or larvae on necrotic tissues, open wounds &
unbroken skin or mucosa.
 Larvae may also be ingested accidentally through
contaminated food.
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15.  Flies lay 500 eggs at a time
directly over the diseased tissue.
 Egg hatch in less than one week
& life cycle is completed within 2
weeks.
 Larvae obtain nutrition from
surrounding tissues & burrow
deeper into soft tissues by
making tunnels separating
mucoperiosteum from the bone.
Meshram VS et al. oral myiasis. Journal of maxillofacial surgery 2004;3:19-20www.indiandentalacademy.com

16.  The larvae are tapered in shape and greyish white in colour,
with transverse rows. They are short, stout, light brown/black
tipped posteriorly & directed spines along the tapering body.
 The patient usually presents due to pain and discomfort.
 Warm humid climate, non healing wound with halitosis can
attract flies to lay egg in it.
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17. Treatment
 Mechanical removal of larvae – traditional method.
 If tissue destruction – surgical exploration
 Others include local application of turpentine oil, iodoform,
ethyl chloride, mercuric chloride, ether, chloroform,.
 Systemic Ivermectin can give favourable results
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