the term myiasis is derived from greek words  muia  and  iasis  , which means  fly  and  disease  , german entomologist fritz zumpt defined myiasis as  the infestation of live human and vertebrate animals with dipterous larvae , which at least for a period , feed on the host 's dead or living tissue , liquid body substances , or ingested food  . human or animal tissue acts as an intermediate host for the larvae in its life cycle . myiasis can be seen worldwide , with a higher incidence being observed in tropical and subtropical regions of africa and america due to the favorable climatic conditions of heat and humidity . in humans , the sites most commonly affected are skin , nose , ears , eyes , anus , vagina , and oral cavity . oral myiasis is associated with nosocomial infections , dental extractions , visits to tropical countries , alcoholism , and mouth breathing , and is commonly seen in mentally disabled individuals and people from low socioeconomic status . a 40-year - old male patient reported to our hospital with a chief complaint of facial wound on the left cheek region for past one month , which was initially smaller and increased progressively to the present large size , with appearance of worms in the wound . on extraoral examination , the ulcer was 5 cm  4 cm in size on the left chin region , including lower lip and infiltrating the underlying tissues with an everted and erythematous border . the affected region was swollen , and the swelling extended to the middle of the upper lip . on the left side of the neck , maggots seen buried deep in the wound in the left cheek region ( preoperative ) on intraoral examination , hard tissue revealed partially edentulous space and poor oral hygiene with severe deposits of calculus and stains . on soft tissue examination , a small fistula was seen in the left lower vestibule at the corner of the mouth . considering the patient 's mental status , history of epilepsy , and poor oral hygiene , it was provisionally diagnosed as an ulcer infested with maggots ( oral myiasis ) . about 1520 maggots were removed with a tweezer following the application of turpentine oil [ figures 2 and 3 ] . the removed maggots were placed in a container , sealed tightly , and disposed off . surgical debridement of the wound was carried out under local anesthesia [ figure 4 ] . the patient was prescribed antibiotic ( cefotaxime 200 mg bd ) , and analgesic ( ibuprofen ) to prevent further infection and to control pain . when the patient was reviewed after a week , the swelling had subsided and wound healing was observed to be satisfactory [ figure 5 ] . removal of maggots using tweezers following turpentine oil application immediate post - operative wound healing satisfactory after a week clinically , myiasis is classified as primary and secondary . in the primary type , larvae feed on living tissue , and in the secondary type , larvae feed on dead tissue . depending upon the condition of involved tissue , myiasis is again classified as accidental myiasis ( larvae ingested along with food ) , semi - specific ( larvae laid on necrotic tissue in wounds ) , and obligatory myiasis ( larvae affects the undamaged skin ) . based on the tissue involved , cutaneous myiasis is subdivided into creeping and furuncle . in creeping type , larvae burrow through or under the skin , and in furuncle type , larvae of the common housefly musca domestica ( indian housefly ) have also been identified in neglected wounds . the adult female flies lay eggs or larvae on food , necrotic tissue , or open wounds . warm humid climate and non - healing wound with halitosis attract the flies to lay eggs . eggs hatch within 24 hours , and the larvae formed release toxins to destroy the host tissue . larvae complete their development in 5 - 7 days , and they then wriggle out of the wound and fall to the ground to pupate . the treatment is primarily manual removal of larvae after the topical application of turpentine oil , mineral oil , chloroform , ethyl chloride , or mercuric chloride . these substances called asphyxiation drugs creates anaerobic atmosphere within the wound causing aerobic parasitic larvae to come to the surface making its removal easier . following the removal of the maggots , surgical wound debridement should be performed . a systemic treatment with ivermectin a semi - synthetic macrolide antibiotic isolated from streptomyces avermitlis is another choice , which is given orally in one dose of 150 - 200 mg / kg of body weight . it activates the release of gamma amino butyric acid , which induces the death of the larvae and their spontaneous elimination . prevention of oral myiasis can be achieved by health awareness , enhancing oral and personal hygiene , and providing proper care to individuals with neurological deficit .
myiasis is a pathologic condition in humans occurring because of parasitic infestation . 
 parasites causing myiasis belong to the order diptera . 
 oral myiasis is seen secondary to oral wounds , suppurative lesions , and extraction wounds , especially in individuals with neurological deficit . in such cases , 
 neglected oral hygiene and halitosis attracts the flies to lay eggs in oral wounds resulting in oral myiasis . 
 we present a case of oral myiasis in 40-year - old male patient with mental disability and history of epilepsy .