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MYIASIS IN PATIENTS WITH SPECIAL NEEDS – CASE STUDY

Ko LWL, Francis J, Lim WT

Introduction: Oral myiasis (oral means “mouth” in Latin; myia means “fly” in Greek),
a term first introduced by Rev. Frederick William Hope in 1840, is a rare pathology
whereby tissues of the oral cavity are infested by the larvae of Dipteran flies,
commonly known as maggots. The predisposing factors of oral myiasis in patients with
special needs, on top of being intellectually, physically and/or mentally disabled,
include medical co-morbidities, low socioeconomic status, malignancy, facial trauma,
persistent mouth opening and poor oral hygiene. Objectives: This case report aims to
highlight the challenges and importance of modified delivery of oral healthcare for
special needs patients in the management of oral myiasis. Oral health education to
caregivers of patients with special needs is also emphasised in the management of
oral myiasis. Case study: Two cases of oral myiasis were seen at the Special Needs
Dentistry Unit. The first case involved a 27-year-old Bidayuh male patient, who was
quadriplegic and cognitively impaired due to hypoxic ischemic encephalopathy as a
complication of severe asthmatic attack. He presented with swelling of upper lip and
palate with infestation of maggots. In the second case, oral myiasis occurred in the
palate of a 65-year-old Malay male who was under palliative care and ventilated
following subtotal colectomy. The challenges in managing these patients include
positioning of wheelchair-bound and bed-bound patients during treatment and
barriers in communication with non-verbal patients with reduced cognitive capacity
and cooperation. The extent of the lesion also required greater palatine artery ligation
and fabrication of appliance as a barrier and to facilitate healing. Anxiety of caregivers
is another aspect to be addressed as part of holistic management. The patients
underwent wound debridement, mechanical removal of maggots following turpentine
application and wound closure. In addition to the standard treatment protocol, a splint
was fabricated to enable secondary healing. Advice on oral hygiene, wound and splint
care was given to caregivers via tell-show-do technique. Both patients compliant for
follow-up review and had good treatment outcome. Conclusion: Patients with special
needs are more prone to develop oral myiasis due to neglected oral hygiene and the
management could be challenging. It is the clinician’s duty to raise awareness to the
caregivers on importance of oral health maintenance and regular dental check-up.
Special care and modifications are needed in the overall management of oral myiasis
in these patients to improve their quality of health and to prevent fatality.

Presented at IADH 2020 Online Research Competition
Published in Medicina Oral, Patologia Oral, Cirugia Bucal, 2021; 26(Suppl 1):1-79. doi: 10.4317/medoral.1122335667796.

Dr Lynn Ko Wei Linn
Dr Jessica Francis
Dr Lim Woei Tatt
Specials Care Dentistry Unit
Sarawak General Hospital
Sarawak State Health Department
Ministry of Health,Malaysia

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