myiasis is a term derived from the greek word  myia  , meaning invasion of vital tissue of humans or other mammals by fly larvae.[15 ] the term  myiasis 
hope in 1940 , and since then , it has been used to designate infestation by the larvae.[68 ] myiasis was defined by zumpt as the infestation of live human and vertebrate animals by dipterous larva , which at least for a certain period feed on host 's dead or living tissue , liquid body substances or ingested food .
a condition similar to myiasis was considered by the hindu mythology as  god 's  punishment to sinners .
a 22-year - old male patient reported to the outpatient department of oral medicine with a primary complaint of worms in the mouth since 4 days .
the medical history revealed that the patient was affected by cerebral palsy since birth [ figure 1 ] .
clinical oral examination revealed an area of ulceration in the anterior palatal aspect of the mouth , accompanied by erythema , redness and bleeding on probing [ figure 2 ] .
external profile of the patient intraoral photograph showing palatal swelling a total of 20 larvae were grasped gently and taken out with the help of tweezers after application of turpentine oil . out of these , only three were viable .
these were then taken to department of parasitology where they were identified as larvae of the common housefly .
histopathological examination of the incisional biopsy specimen revealed dense inflammatory infiltrate comprising chiefly lymphocytes in the connective tissue stroma .
this parasitic infestation frequently occurs in rural areas , infecting livestock and pets such as dogs and cats .
after the fly lays eggs in the dead and decaying tissues , the larvae hatch in about 810 hours , soon after which they burrow into the surrounding tissues ; and in this stage , there will be tissue inflammation ensuing discomfort , which makes the patient consult a doctor .
the opening of the burrow is usually kept patent with induration of the marginal tissues , and is raised forming a dome - shaped  warble  .
they position their heads down so that the posterior spiracles could become exposed to the open air to make respiration possible .
after the young larvae penetrate the skin of the host , they take 812 days to develop into the prepupal stage and then leave the host to pupate . while in human skin
the most common anatomic sites for myiasis are the nose , eye , lung , ear , anus , vagina and , more rarely , the mouth .
incidence of oral myiasis as compared to that of cutaneous myiasis is less as the oral tissues are not permanently exposed to the external environment .
it has been reported among epilepsy patients with lacerated lips following a seizure , incompetent lips and thumb sucking habits , advanced periodontal disease , at tooth extraction sites and patients with tetanus with mouth propped open to maintain their airway .
the stage of larvae lasts for 68 days during which they are parasitic to human beings .
the larvae have backward directed segmental hooks with which they anchor themselves to the surrounding tissue .
they are photophobic and tend to hide deep into the tissues for a suitable niche to develop into pupa .
this unusual type of gingival myiasis may occur in an unconscious or sleeping person when the mouth is left open .
periodontal disease of the oral cavity , with pockets , provides a perfect environment for the eggs to hatch and for the larvae to grow in the warm and moist conditions .
histological examination of tissue has been reported to show evidence of dense inflammation , dystrophic calcification , and foreign bodies compatible with features of abscess .
the standard treatment of myiasis is manual removal with hemostatic or clinical pincers , associated with or without the administration of topical asphyxiation drugs , which forces the larvae to come out .
it is important to remove all the larvae , otherwise the cavity does not heal properly and can also become chronically infected . various substances ( ether , chloroform , olive oil , calomel , iodoform , phenol mixture ) have been recommended ; however , they were found to produce controversial results .
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
to conclude , myiasis affects mostly the uncovered body areas where oviposition is easily carried out .
it frequently affects low socioeconomic level individuals with poor hygiene habits and unhealthy patients with psychiatric disorders , diabetics , and immunocompromised patients . undoubtedly ,
preventive approach measures , including basic health care , hygiene , access to primary health service , and safe water and drainage , are fundamental to prevent cases such as this one .
 myiasis is a relatively rare condition arising from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies . 
 it is an uncommon clinical condition , being more frequent in underdeveloped countries and hot climate regions , and is associated with poor hygiene , suppurative oral lesions ; alcoholism and senility . 
 its diagnosis is made basically by the presence of larvae . 
 the present article reports a case of oral myiasis involving 20 larvae in a patient with neurological deficiency . 
Introduction
Case Report
Discussion
Conclusion