Background

Myiasis, defined as the infestation of human or animal tissues by dipteran fly larvae, is a rare but clinically significant parasitic condition. It is more frequently observed in tropical and subtropical regions, where environmental conditions promote fly proliferation. Individuals with poor hygiene, immunosuppression, diabetes mellitus, malignancies, or open wounds are particularly vulnerable, as these factors provide favorable entry points for larvae. While cutaneous and wound myiasis are relatively well documented in the literature, oral and paranasal forms are extremely rare and often associated with considerable morbidity due to the potential for extensive tissue destruction. Oral myiasis is typically associated with poor oral hygiene, dental pathology, or neurological disorders that impair self-care, whereas paranasal myiasis may manifest with nasal obstruction, foul odor, and, in severe cases, intracranial complications if left untreated. Due to their rarity, early clinical recognition and timely intervention are critical for preventing adverse outcomes.

Case Presentation

We report two rare cases of myiasis: one involving the oral cavity and the other affecting the paranasal sinuses. The first case was a 59-year-old male with poor oral hygiene and multiple comorbidities, presenting with ulcerative oral mucosal lesions and visible larval infestation. The second case involved a 68-year-old female patient with amyotrophic lateral sclerosis (ALS) receiving palliative home care, who presented with nasal discharge and intranasal larvae consistent with paranasal myiasis. Both patients underwent extensive mechanical debridement and larval removal, followed by local wound care and supportive therapy. Additionally, the patient with nasal myiasis underwent bilateral endoscopic sinus surgery to ensure complete clearance of the infestation. These cases underscore the importance of early recognition and prompt treatment of myiasis, especially in high-risk individuals. The pathophysiology, diagnostic challenges, and treatment strategies are discussed, emphasizing the need for a multidisciplinary approach to care.

Conclusion

Oral and paranasal myiasis remain rare yet serious conditions that require immediate clinical attention. Preventive strategies, including improved hygiene and early identification in at-risk populations, are essential to reducing associated morbidity. These case reports contribute to the limited literature on this topic and highlight the importance of comprehensive, multidisciplinary management.