Oral myiasis: a case report and literature review.

Myiasis is the infestation of tissues and organs of animals and humans by certain Dipteran fly larvae. This phenomenon is well documented in the skin, especially among animals and people in tropical and subtropical areas. Oral myiasis is a rare condition and can be caused by several species of Dipteran fly larvae and may be secondary to serious medical conditions. Upon removal of the larvae, the tissues seem to recover with no subsequent complications and with no need for further treatment. Here we describe a case of oral myiasis within the gingiva of a healthy young man caused by the larvae of Wohlfahrtia magnifica (Family Sarcophagidae), in which infection may have been due to ingestion of infested flesh. Reviewing the literature revealed that most cases of oral myiasis tend to be multiple and to occur in anterior segments of the jaws rather than in posterior segments as in the case we describe here.

Botulinum toxin injections for children with excessive drooling.

The objective of this study was to evaluate the feasibility of ultrasonography-guided injections of botulinum toxin A into the parotid glands of children with severe drooling (sialorrhea). Excessive drooling is common in children with chronic neurologic disorders. Preliminary observations in adults suggest that injections of botulinum toxin A into the parotid glands can decrease drooling, but the optimal dose, sites of injection, and concomitant use of imaging during injections and its use for children have not been established. Ultrasonography was used to guide the injection of botulinum toxin (10-25 IU) into both parotid glands of nine children with excessive drooling. Subjective and objective measures of the severity of drooling were collected before and after botulinum toxin A injections. A booster injection was provided if the initial response was inadequate. Injections were well tolerated, and no adverse reactions were observed. Ultrasonography revealed that the parotid gland showed a variable depth, extent, and vascularization. Eight of nine patients needed a booster injection after 1 month. Objective measures of drooling severity were improved in seven of nine patients. However, subjective improvement was reported in only three of nine patients, and this improvement was functionally significant in only one patient. Although intraparotid injection of botulinum toxin A is safe and causes a reduction in saliva production in children, the doses used in this study did not result in functionally significant improvement. Higher doses of botulinum toxin A in the parotid glands or concomitant injections into the submandibular glands can increase the efficacy of these injections. Variability in size, depth, and vascular supply of the parotid gland suggests the importance of ultrasonography guidance for optimizing injections. These results underscore the need for further studies to establish the efficacy of this treatment in children.