Exuberant Oral Myiasis Caused by Musca domestica (Housefly)
A 42-year-old female patient reported with a chief complaint of pain and swelling in upper front teeth since past 3 days. History of present illness revealed discomfort and mobility with upper anterior teeth since 2 months and difficulty in eating since last 20 days.\nThe patient was a farm laborer with low socioeconomic background residing in rural area. Extra-oral examination revealed retruded chin and proclinated maxillary anteriors (Class II overjet with incompetent lips), few of which appeared to be on the verge of exfoliation. There was a diffuse swelling involving the upper lip with prominence of the vermilion border. The lip also appeared slightly erythematous, though there was no rise in local temperature [].\nIntra-oral examination revealed poor oral hygiene, fetid odor and severe periodontitis. There was a solitary swelling involving the anterior maxilla extending from mesial surface of maxillary right first premolar to the distal surface of maxillary left canine measuring approximately 6 × 4 centimeters. The upper anterior vestibule was obliterated and demonstrated cleavages and tunnels in labial mucosa and underlying tissues with numerous visible larvae that exhibited wriggling movement. The involved mucosa was swollen, erythematous and also bled easily. Maxillary anterior teeth exhibited pathologic migration along with extrusion and severe gingival recession extending to the apical thirds. Maxillary incisors (teeth # 11, 12, 21 and 22) were carious. Necrotic areas and calculus deposition was also associated with these teeth []. Occlusal radiograph of maxilla revealed destruction of the supporting alveolar bone with floating teeth []. Based on these clinical and radiographic findings, the case was diagnosed as oral myiasis.\nTreatment plan was primarily aimed at encouraging the larvae to come out of the involved area. Topical application of turpentine oil was done with autoclaved gauze soaked in it in order to asphyxiate the larvae. Subsequent mechanical removal of maggots with blunt cotton pliers harvested approximately 55-65 maggots. These were preserved in 40% formaldehyde and identified as larvae of Musca domestica or housefly []. Oral drugs including Doxycycline 100 mg BD on first day followed by OD dose for next 5 days, Metronidazole 400 mg TID for 5 days, Ivermectin 3 mg BD for 5 days and Diclofenac sodium 50 mg TID for 3 days along with a supplement of B-Complex (OD) for 15 days were prescribed. The patient was also advised to rinse with 0.2% Chlorhexidine gluconate mouthwash 10 ml BD for 7 days.\nLarvae were removed every day manually as described above. On the third day, when the infection was under control, the mobile teeth were extracted and the wound was debrided in order to remove the necrotic tissue. Finally, the involved site was re-examined for remaining larvae or tissue tabs before being sutured. The patient was educated and motivated with regards to personal hygiene measures with special emphasis on oral hygiene instructions. Three week follow-up demonstrated satisfactory and uneventful healing with complete resolution of lesions.