7/27/2019 x14

1/2

I J C R I I n t e r n a t i o n a l J o u r n a l o f C a s e R e p o r t s a n d I m a g e s , V o l . N o . , 2 0 1 3 . I S S N [ 0 9 7 6 - 3 1 9 8 ]

I J C R I 2 0 1 3 ; ( ) : * * * * .

www.ijcasereportsandimages.com

Extensive maxillofacial and oral myiasis

Felipe P Dalto, Andr Ricardo Nos, Rodrigo C Mosca,Andrea Mantesso

Disclaimer: This manuscript has been accepted forpublication in International Journal of Case Reports and

Images (IJCRI). This is a pdf file of the provisionalversion of the manuscript. The manuscript will under gocontent check, copyediting/proofreading and contentformating to conform to journal's requirements. Pleasenote that during the above publication processes errorsin content or presentation may be discovered which will

be rectified during manuscript processing. These errorsmay affect the contents of this manuscript and finalpublished version of this manuscript may be extensivelydifferent in content and layout than this provisional PDF

version.

CASE REPORT

A 28-year-old homeless man was brought by a policeofficer to the emergency service of the Regional SulHospital (Sao Paulo - Brazil) for evaluation of anextensive destruction of the oral and maxillofacialtissues. The patient was a heavy smoker (three packs ofcigarettes per day) and according with his medicalrecords he had a previous diagnosis of oral squamouscell carcinoma, but decided not get it treated. Three

years later, the surface of the swelling revealed an extensive necrotic ulcer extending to the mouth, lips,nose and neck with live maggots visible moving. Aroundone hundred and ten larvae were surgically removedand the necrotic tissue was debrided (Figure 1A, B). The

patient was sent to the oncology service for a wholebody evaluation, however, hepassed away two weekslater due to systemic complications.

DISCUSSION

The term myiasis is applied to the injurious actionthat a parasites of the order Diptera causes to theorganism of vertebrates in the living or dead tissue in

which they grow [1]. It is more common in animals andit has been rarely reported in humans [2]. Moreover,considering that myiasis develops by direct infestation

of tissues by larvae (maggots) laid by flies [1], the mouthis not a common place for its development compared

with dermis or other tissues.

C A S E S E R I E S O P E N A C C E S S

F e l i p e P D a l t o

1

, A n d r R i c a r d o N o s

2

, R o d r i g o C M o s c a

3

,

A n d r e a M a n t e s s o

1

A f f i l i a t i o n s :

1

D e p a r t m e n t o f O r a l P a t h o l o g y , S c h o o l o f

D e n t i s t r y , U n i v e r s i t y o f S o P a u l o , B r a z i l ;

2

D e p a r t m e n t o f

B u c o m a x i l o f a c i a l S u r g e r y , S c h o o l o f D e n t i s t r y , P a u l i s t a

U n i v e r s i t y , B r a z i l ;

3

D e p a r t m e n t o f B i o t e c h n o l o g y , I n s t i t u t e

o f E n e r g e t i c a n d N u c l e a r R e s e a r c h / N a t i o n a l C o m m i t t e e o f

N u c l e a r E n e r g y , U n i v e r s i t y o f S o P a u l o , B r a z i l .

C o r r e s p o n d i n g A u t h o r : D r . A n d r e a M a n t e s s o ; O r a l

P a t h o l o g y D i s c i p l i n e D e n t a l S c h o o l - U n i v e r s i t y o f S o

P a u l o . , A v . P r o f e s s o r L i n e u P r e s t e s , 2 2 2 7 - C E P : 0 5 5 0 8 -

9 0 0 - S o P a u l o / S P . B r a z i l ; P h e : + 5 5 1 1 3 0 9 1 7 9 0 2 ; F a x : +

5 5 1 1 3 0 9 1 7 8 1 4 ; E m a i l : m a n t e s s o @ u s p . b r

R e c e i v e d : 1 0 M a y 2 0 1 2

A c c e p t e d : 0 4 J u n e 2 0 1 2

P u b l i s h e d : 0 1 J a n u a r y 2 0 1 3

D a l t o e t a l . 1

A C C E P T E D M A N U S C R I P T P R O V I S I O N A L P D F

Figure 1: A, B) Clinical aspect of the patient upon arrival at thehospital. It is possible to observe an extensive necrotic ulcerextending to the mouth, lips, nose and neck with visiblelivemaggots. Around one hundred ten larvae were surgicallyremoved. The patient was seriously compromised and requiredmechanical assistance to breath.

7/27/2019 x14

2/2

I J C R I I n t e r n a t i o n a l J o u r n a l o f C a s e R e p o r t s a n d I m a g e s , V o l . N o . , 2 0 1 3 . I S S N [ 0 9 7 6 - 3 1 9 8 ]

I J C R I 2 0 1 3 ; ( ) : * * * * .

www.ijcasereportsandimages.comD a l t o e t a l .

2

Oral myiasis is usually associated with poor hygiene,wound healing, mouth breathing, mental impairment orsenility [3]. In our case, the patient was clearlypredisposed to the infestation considering the fact thathe was a homeless, had unhygienic living condition, andhad a previously untreated oral carcinoma.

The treatment of oral myiasis in most cases includesonly surgical exploration to remove the larvae andnecrotic tissue [3]. Alternatively, use of medicines suchas invermectin has also been proved to be efficacious, byenhancing parasitic death and emergence to tissuesurface [4].

Additionally, it is suitable to know that at least in lesssevere cases differential diagnosis should be considered[3, 5]. Initial infestation can easily mimic gingivalinflammations. Likewise, some cases of myiasis inassociation with oral tumors have also been reported[5].

CONCLUSION

In conclusion, the most effective action forprevention of human myiasis is by education andimprovement of general sanitary conditions.Unfortunately in poor or developing countries likeBrazil, some people still live in poor environmentsassociated with compromised hygiene and lack ofinformation which can leads to human myiasis.

*********

Dalto FP, Nos AR, Mosca R, Mantesso A. Extensivemaxillofacial and oral myiasis. International Journal ofCase Reports and Images 2013():*****.

*********

doi:10.5348/ijcri-2013-01-265-CI-19

*********

Author Contributions

Felipe P Dalto Substantial contributions toconception and design, Acquisition of data, Analysis andinterpretation of data, Drafting the article, Revising itcritically for important intellectual content, Finalapproval of the version to be published

Andr Ricardo Nos Substantial contributions toconception and design, Acquisition of data, Analysis andinterpretation of data, Drafting the article, Revising itcritically for important intellectual content, Finalapproval of the version to be publishedRodrigo C Mosca Substantial contributions toconception and design, Acquisition of data, Analysis andinterpretation of data, Drafting the article, Revising itcritically for important intellectual content, Finalapproval of the version to be published

Andrea Mantesso Substantial contributions toconception and design, Acquisition of data, Analysis andinterpretation of data, Drafting the article, Revising itcritically for important intellectual content, Finalapproval of the version to be published

GuarantorThe corresponding author is the guarantor ofsubmission.

Conflict of InterestAuthors declare no conflict of interest.

Copyright Felipe P Dalto et al. 2013 This article is distributedunder the terms of Creative Commons Attribution 3.0License which permits unrestricted use, distribution andreproduction in any means provided the original authors

and original publisher are properly credited. (Please seewww.ijcasereportsandimages.com /copyright-policy.phpfor more information.)

REFERENCES

1. Meinking TL, Burkhart CN, Burkhart CG. Changingparadigms in parasitic infections: commondermatological helminthic infections and cutaneousmyiasis. Clin Dermatol. 200321:407-16.

2. Kumar SL, Manuel S, John TVand Sivan MP.Extensive gingival myiasis - Diagnosis, treatment,and prevention. J Oral Maxillofac Pathol. 2011

Sep,15(3):340-3.3. Gomez RS, Perdigo PF, Pimenta FJ and AC Rios

Leite. Oral Myiasis by Screwworm CochliomyHominivorax. Br J Oral Maxillofac Surg.200341:115-6.

4. Vale DS, Cavalieri I, Araujo MM, Santos MB, dosSantos Canellas JV, Espnola LV, et al. Myiasis inpalate by Cochliomyia hominivorax. J CraniofacSurg. 2011 Nov22(6):57-9.

5. Carvalho RW, Santos TS, Antunes AA, et al. Oral andmaxillofacial myiasis associated with epidermoidcarcinoma: a case report. J Oral Sci. 2008Mar50(1):103-5.