Murari Kaimal1* and Col. Ajay Mallick2
1Senior Clinical Fellow-ENT, Salford Royal Foundation Trust, Stott Lane, Manchester, UK
2Armed Forces Medical Services, India
*Corresponding Author: Murari Kaimal, Senior Clinical Fellow-ENT, Salford Royal Foundation Trust, Stott Lane, Manchester, UK.
Received: January 15, 2020; Published: January 21, 2020
Myiasis is a zoonotic disease characterized by infestation of dipterous larvae of certain fly species. Mainly reported from tropical areas, the reported cases are dwindling owing to the increased level of public awareness and improved healthcare access. The larvae maybe obligate or facultative parasites depending on the species infesting.
Our case is a 47-year-old lady with no co-morbidities, presented with chief complaints of headache and left hemi-facial pain of 2weeks duration with nasal blockage and occasional bloodstained discharge from left nostril. Investigations and work up, including nasal endoscopy revealed maggot infestation in the left nostril with extensive soft tissue destruction, necrosis and sloughing.
She was diagnosed as a case of nasal myiasis and was treated by meticulous endoscopic removal of the maggots, surgical debridement and antibiotic coverage for secondary bacterial infection. The symptoms resolved over a period of 2 weeks with successful removal of all larvae. We were able to avert serious orbital and intracranial complications and the patient was discharged with a healing nasal cavity.
However, on subsequent follow-ups it was noted that the mucosa healed well but, she had developed significant persistent synechiae which ultimately required- endoscopic endonasal Draf-3 procedure to establish patency of the frontal sinus subsequently. Myiasis of nasal cavity is a rare condition mainly reported from the tropics, there are only few case reports and no consensus on best treatment strategy. We propose a treatment approach with meticulous endoscopic maggot extraction and mucosal debridement, along with saline nasal douching and good personal hygiene. Antibiotics maybe added in cases suspected of secondary bacterial infection or intracranial extension, with meticulous follow-up by Diagnostic nasal endoscopy (DNE) for synechiae and Osteo-meatal complex (OMC) blockage.
Keywords: Myiasis; Maggots; Nasal Infestation; Larvae; Parasitic Infection; Para Nasal Complications; Chrysomya Bezziana; Screw Worm; Ether; Nasal Discharge; Nasal Blockage; Nasal Toilet; Draf-3; Nasal Toilet; Nasal Debridement
Citation: Murari Kaimal and Col. Ajay Mallick. “Endoscopic Management of Nasal Myiasis – An Unusual Presentation with Secondary Sino-Nasal Complications". Acta Scientific Otolaryngology 2.2 (2020): 14-17.
Copyright: © 2020 Murari Kaimal and Col. Ajay Mallick. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.