Atrophic rhinitis (AR) is a chronic nasal disease characterized by atrophy of the nasal mucosa and turbinates. Occasionally, nasal myiasis complicates AR. This case illustrates an uncommon complication of nasal myiasis, palatal perforation. A 35-year-old South Asian woman presented with recurrent bilateral epistaxis and expulsion of maggots from the nose. She had a history of nasal obstruction, foul-smelling nasal discharge, and anosmia. On examination, the patient had atrophied nasal turbinates and later developed 2 perforations in the palate. She was offered conservative management for AR. Besides, she underwent manual and endoscopic removal of maggots in multiple settings and was isolated in a mosquito net to prevent reinfestation. Nasal myiasis can complicate AR in tropical regions. Early diagnosis of AR and simple prophylactic measures, such as nasal douching and use of mosquito nets while sleeping, can prevent complications such as palatal perforation and intracranial extension caused by nasal myiasis.
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