INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
Complaint of massive, painful
swelling of upper left cheek &
involving the eye.
extraction of upper left back
teeth 5 days back.
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.
Vital signs - 150/90,
Extra oral examination –
swelling of left cheek &
Intra oral examination
Non healing extraction site
Poor oral hygiene
Irrigation of extraction
site revealed maggots
8-10 maggots removed
PNS view taken to see the status of
revealed RBS of 250mg /dl.
ELISA : -ve
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.
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
T. Diclofenac sodium (Diclo) 50mg
1-0-1 x 5 days
T. Ranitidine (Rantac) 150mg 1-0-1
x 5 days
After 1 month
Failure of patient to report after
a week for review
After one month – c/o difficulty in
eating, regurgitation of fluids, &
O/E – necrotic left maxillary
Postoperative healing uneventful over 4 months follow upwww.indiandentalacademy.com
Before treatment After treatment
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
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
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
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
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.
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