Management of Tracheostomy Site Myiasis

Abstract

Introduction Myiasis, from the Greek myia for “fly,” has been defined as the infestation of live human or vertebrate animals with larvae of the insect order Diptera (flies), which feed on living or necrotic tissue [1]. Myiasis can also be classified according to the site of infestation. Cutaneous myiasis involves the invasion of the skin, with the most common target being a wound, near which an obligatory or facultative parasitic fly will lay eggs [1,2]. In “wound myiasis,” both healthy and necrotic tissues can be fed on by the larvae, depending on the conditions and species of fly involved. Apart from the skin, the eyes, ears, nose, and sinuses represent relatively common sites of attack whereas less common sites are the mouth, throat, urogenital, and gastrointestinal tracts [1,2]. We present a case with tracheostomy wound myiasis and detailed description of its management. Case Blog A 62 year male patient presented with respiratory distress at ENT emergency. On indirect laryngoscopy a supraglottic mass was seen. The patient underwent emergency tracheostomy. A 7.5 mm cuffed tracheostomy tube was inserted. Biopsy was taken from the supraglottic growth under direct laryngoscopic view. Histopathologic report was well differentiated sqaumous cell cancer. The tracheostomy tube was changed to uncuffed tube and the patient was discharged following referral to radiotherapy department. The importance of proper tracheostomy tube care was well explained to the patient and his relatives. The patient was irregular during followup period and presented to ENT opd after 3 weeks with complaints of itching sensation at the tracheostomy wound site. On examination maggots were seen in the tracheostomy wound (Figures 1 and 2).