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January 10, 2019

Traumatic Lower Lip Myiasis—A Rare Presentation

Author Affiliations
  • 1Department of Otorhinolaryngology Head, and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • 2Department of General Surgery, People’s Dental College and Hospital, Kathmandu, Nepal
  • 3Department of Otorhinolaryngology Head and Neck Surgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
JAMA Otolaryngol Head Neck Surg. 2019;145(2):194-195. doi:10.1001/jamaoto.2018.3858

The infestation of body cavities with insects and flies has been known to mankind since ancient times. The understanding of the term myiasis seems to be changing with time. Treatment consists of manual removal of the maggots. Turpentine oil or topical irritants assist with elimination.1

We report a unique case of myiasis in a homeless man in his 50s with alcohol use disorder who sustained a lower lip injury by stone 5 days previously. According to the patient, the wound did not improve despite regular dressings and medications. He started to have constant wriggling sensation over the lower lip for 2 days. However, he denied any medical history of rash, shortness of breath, or similar wounds elsewhere on his body. He was afebrile with normal blood parameters. We cleaned the wound and debrided the necrotic tissue under local anesthetic. There was a cavity approximately 3 × 2 cm2 full of multiple moving larvae (Figure 1). Thus he was diagnosed with traumatic lower lip myiasis. He was hospitalized and treated with regular dressings with turpentine oil and surgical debridement of the wound along with the manual removal of the larvae under local anesthesia (Video). A total of 76 larvae were removed. Each larva was approximately 2 cm long, creamy white, and cylindrical (Figure 2). He was discharged on the seventh day of admission and followed up after 1 week with good results.