Oral myiasis in a maxillofacial trauma patient
A 40-year-old male patient with maxillofacial trauma reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of inability to close the mouth and difficulty in chewing the food. History revealed trauma 3 days back due to physical assault.\nOn clinical examination, patient had a laceration of upper lip and palatal mucosa []. He also had a posterior open bite. In addition, patient had a very poor oral hygiene []. Further, there were multiple maggots crawling out from the lacerated palatal mucosal wound. Orthopantamogram and computed tomography scan showed a fracture of left parasymphysis, bilateral condyle and left coronoid fracture []. After obtaining a detailed case history, clinical, radiographic and hematological investigations, a diagnosis of maxillofacial trauma with oral myiasis was made. The patient was planned for open reduction and internal fixation for fracture and manual removal of maggots under general anesthesia.\nCotton bud impregnated with turpentine oil was applied to the lacerated mucosa for a minimum of 10-12 min. After these maggots were manually removed with the help of blunt tweezer and curved forceps and then sent for entomological examinations [Figures and ]. Further management included surgical removal of necrotic tissue slough present and irrigating the area with saline, H2O2 and then with betadine followed by metronidazole. After debridement of the region, intermaxillary fixation with plating was done in parasymphysis and condylar region []. The patient was put on tablet Ivermectin 6 mg OD for 5 days along with antibiotic cover of doxycycline 100 mg BD and Metronidazole 100 ml 8 h given for 5 days. The patient was advised to maintain proper oral hygiene and rinse the wound with 0.2% Chlorhexidine mouthwash, 3 to 4 times daily.\nAll maggots were removed including dead larvae in approximately 2 days. Patient was discharged on 4th day after informing about wound care. Follow-up appointment was given. Extra oral sutures were removed and patient was recalled periodically. On the 14th day wound had healed completely [Figures and ]. Lab analysis report of maggots, described it as house fly (musca nebulo) common Indian house fly.