Management of myiasis in advanced head and neck cancers: a comprehensive review

Accidental myiasis, defined as the infestation of living or necrotic tissue by Diptera larvae, represents a neglected but profoundly distressing complication in patients afflicted with advanced malignancies, particularly head and neck cancers (HNC). HNC constitutes a major global health burden, with an exceptionally high incidence in low- and middle-income countries (LMICs), such as India, where delayed presentation often culminates in large, ulcerative malignant fungating wounds (MFWs). These MFWs, coupled with environmental factors, socioeconomic disadvantage, poor hygiene, and patient debility, create a fertile environment for obligatory parasitic fly species, notably Chrysomyia bezziana and Cochliomyia hominivorax, whose larvae aggressively destroy host tissues. The resulting infestation leads to severe pain, relentless odor, rapid tissue erosion, and profound psychological distress, demanding urgent and definitive intervention. Given the paucity of standardized protocols, this review synthesizes the current global and Indian evidence (2000-2025) on the pathophysiology, clinical burden, and management of malignant wound myiasis. The evidence strongly supports an integrated approach centered on systemic antiparasitic administration. Specifically, the "Triple Therapy" regimen-Oral ivermectin, albendazole, and clindamycin-is highlighted for its promising efficacy reported in a single-center prospective cohort in achieving rapid clearance (> 90% reduction in larval burden by Day 3) and significantly improving associated palliative metrics, including pain and odor control. Practical guidelines emphasizing patient safety, ethical use of topical agents, and the essential role of comprehensive psychosocial and caregiver support are provided to establish a high-value, patient-centered standard of care.