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Paper text:
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 .
orthopantamogram and computed tomography scan showed a fracture of left parasymphysis , bilateral condyle and left coronoid fracture [ figure 3 ] . after obtaining a detailed case history , clinical , radiographic and hematological investigations , a diagnosis of maxillofacial trauma with oral myiasis
the patient was planned for open reduction and internal fixation for fracture and manual removal of maggots under general anesthesia .
intra oral photograph showing laceration in palate and upper lip intra oral photograph showing disturbed occlusion pre - operative computed tomography scan cotton 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 4 and 5 ] .
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 [ figure 6 ] .
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 .
intra oral debridement of the lesion intraoral photograph showing maggots maxillomandibular fixation all maggots were removed including dead larvae in approximately 2 days .
lab analysis report of maggots , described it as house fly ( musca nebulo ) common indian house fly .
myiasis is a rare condition in human beings although frequently reported in vertebrate animals , main parasites being flies of order of diptera ( maggots ) , which feed on the host 's dead or living tissue . in this condition ,
the soft - tissue parts of the oral cavity are invaded by parasitic larvae of these flies .
hope et al . , described the first incidence of this parasitosis in 1840 , common infestations being reported in open wounds and dead tissues ; but , cavities such as ears , nose and oral cavity may be involved .
this parasitic infestation commonly seen in mouth breathers , alcoholism , senility , in oral and maxillofacial traumas or in old age groups especially mentally handicapped persons .
low socio - economic status , immunocompromised state , debilitated and unhygienic living conditions may also act as predisposing factors .
the traditional management of oral myaisis is mechanical removal using hemostats or ordinary clinical pincers .
when there are multiple larvae , extensive tissue destruction or in an advanced stage of development of larva as in the present case , adjuvant measures like treating the area with ether or comparable solvents are advocated in literatures , which irritate the maggots causing larval asphyxia and forcing them out of their hiding place .
local application of several substances such as oil of turpentine , mineral oil , ether , chloroform , ethyl chloride , mercuric chloride , creosote , saline , phenol , calomel , olive oil , iodoform , can be used to ensure complete removal of larvae .
male predilection of occurrence has been noted in most literatures because of their more outdoor activities and neglecting the oral hygiene when compared to the female counterpart .
ivermectin , a semi  synthetic macrolide antibiotic , is found safe for human use as proposed by shinohara et al . and osorio et al . in some cases
myiasis is a rare disease primarily caused by the invasion of tissue by larvae of certain dipteran flies . 
 oral myiasis is still more  rare  and  unique  owing to the fact that oral cavity rarely provides the necessary habitat conducive for a larval lifecycle . 
 common predisposing factors are poor oral hygiene , halitosis , trauma , senility , learning disabilities , physically and mentally challenged conditions . 
 oral myiasis can lead to rapid tissue destruction and disfigurement and requires immediate treatment . 
 treatment consists of manual removal of maggots from the oral cavity after application of chemical agents . 
 good sanitation , personal and environmental hygiene and cleanliness and special care for debilitated persons are the best methods to prevent oral myiasis . 
 this case report describes the presentation of oral myiasis caused by musca nebulo ( common house fly ) in a 40-year - old male patient , with recent maxillofacial trauma . 
 the patient was treated by manual removal larvae by topical application of turpentine oil , followed by surgical debridement of the wound and open reduction and internal fixation of the fracture .