International Journal of Clinical Case Reports 2017, Vol.7, No.6, 23-27
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Figure 3 Occlusal radiograph revealing no involvement of bone confirming it to be only a soft tissue lesion
2 Discussion
Oral myiasis is caused by the flies of dipteral which normally develop in decaying tissues (Sheikh et al., 2011).
Factors favoring primary oral infection include poor oral hygiene, halitosis and non-closure of mouth for
prolonged periods due to varying reasons. Few cases of oral myiasis have, also, been reported in healthy
individuals with acceptable oral hygiene (Yazar et al., 2005). The present patient was, also, ill and had abounded
life and abscess in the upper anterior region which was open all the time exposed to the flies to harbor and lay
eggs. The female fly deposits its eggs in the presence of favorable conditions. After hatching, the larvae develop in
the moist, warm environment, burrow into the oral tissues and obtain nutrition and grow (Yazar et al., 2005).
Primary oral myiasis is usually located in the anterior part of the oral cavity affecting the anterior segments of
both the jaws and palate suggesting a direct invasion of tissues. Rarely, posterior regions of the oral cavity are
involved due to ingestion of infected material like meat (Sattur et al., 2012). The life cycle of these flies starts with
the egg stage followed by the larvae, pupa and finally, the adult fly (Sharma et al., 2008). Open wounds, ulcers
and open sores provide a favorable condition for growth of these. After the fly lays eggs in the dead and decaying
tissues, the larvae hatch in about 8-10 hours and immediately burrow into the surrounding tissues. In this stage,
there will be tissue inflammation leading to pain and other signs of discomfort. This burrowing may cause
separation of the muco-periosteum from the bone. The heads of the larvae are positioned downwards so that the
posterior spiracles become exposed to the open air to make respiration possible (Pereira et al., 2010). After the
young larvae penetrate the skin to host, they take 8 to 12 days to develop into the pre-pupal stage and then, leave
the host to pupate. This stage of larvae lasts for 6 to 8 days during which they are parasitic to the host. They hide
deep into the tissues as they are photophobic which, also, helps them to secure a suitable niche to develop into the
next stage, pupa. The surrounding bacteria release proteolytic enzymes which decompose the tissues and the
larvae feed on this rotten tissue. The infected tissues frequently release a foul smelling discharge (Pereira et al.,
2010). In the present case, also, larvae were present deep into the tissues in the anterior palatal region. There are
two forms depending upon the condition of the tissues which are involved:
A) Obligatory where the infecting maggots require living tissues for the larvae development; and
B) Facultative where flies use necrotic wounds to lay eggs and incubate their larvae (Koteswara and Prasad,
2010).
An early diagnosis of myiasis can prevent involvement of deeper tissues. Management should be aimed towards
the elimination of larvae (Yazar et al., 2005). The traditional management of myiasis is the mechanical removal of
maggots (Rossi-Schneider et al., 2007). In case of multiple larvae and in advanced stages of development and
tissue destruction, local application of various agents including oil of turpentine, larvicidal drugs like Negasunt,
mineral oil, ether, chloroform, ethyl chloride, mercury chloride, phenol, saline, creosote, calomel, olive oil and
idoform can be used to ensure complete removal of all larvae (Shinohara et al., 2004; Reddy et al., 2012).
Turpentine, a toxic chemical, induces tissue necrosis. When applied topically, it produces reversible damages like
epithelial hyperplasia, hyperkeratosis and ulcerations (Ramli and Rahman, 2002). This is followed by surgical
