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Oral myiasis / dental implant courses


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.

Published in: Education
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Oral myiasis / dental implant courses

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing Dental Education
  2. 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.
  3. 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.
  4. 4. Clinical examination  General examination  Vital signs - 150/90, 103o F  Extra oral examination – swelling of left cheek & eye.
  5. 5. Intra oral examination  Non healing extraction site 24,25  Poor oral hygiene
  6. 6.  Irrigation of extraction site revealed maggots  8-10 maggots removed from communication
  7. 7. Diagnosis  Myiasis  PNS view taken to see the status of bone  Hematological examination revealed RBS of 250mg /dl.  ELISA : -ve
  8. 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.
  9. 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
  10. 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
  11. 11. Left maxillectomy Postoperative healing uneventful over 4 months follow
  12. 12. Before treatment After treatment
  13. 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;
  14. 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.
  15. 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;
  16. 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.
  17. 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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