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. periodontitisJan - 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 9,913 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,