emergency department complaining of inability to close her mouth or swallow due to a mass that had been hanging out of her oral cavity for the last few hours (Fig. 1). During the previous three months she had complained of progressive dysphagia and right nasal obstruction, with recurrent attacks of URTI. A severe bout of coughing brought the mass into the oral cavity relieving the dysphagia temporarily but forcing the patient to attend the accident and emergency department.

Past history included an emergency tracheostomy eight years ago with subsequent removal of an avulsed antrochoanal polyp, which was causing stridor. On general and ENT examination, a trilobed fleshy mass was identified hanging out of the oral cavity. The mass was firm in consistency, mobile, non-tender and not attached to the tongue, palate or oral cavity mucosa. It did not bleed on touch. Scarring from the previous tracheostomy was seen on examination of the neck. There were no other relevant features on history or examination. High resolution computed tomography (HRCT) of her paranasal sinuses demonstrated opacity in the right maxillary sinus and right nasal cavity with a mass in the nasopharynx and oral cavity, which was non-enhancing with contrast media.

Fig. 1 : Photo showing the mass hanging out of oral cavity

Considering the nature of presentation, examination findings, past history and HRCT paranasal sinuses findings, the patient had emergency endoscopic sinus surgery under general anaesthesia. Nasal endoscopic examination using 0º Hopkins Road Telescope revealed a mass with stalk attached to the accessory ostium of the right middle meatus. Clearance of the right maxillary sinus was carried out and the mass was delivered per-orally. It was 14 cm in length, 5 cm in diameter, with length of pedicle measuring 4 cms. Histopathology showed typical features of an allergic polyp i.e. an oedematous eosinophilic polyp, with goblet cell hyperplasia, thickening of the basement membrane and a predominantly eosinophilic infiltrate. The patient is on regular follow-up with no recurrence to date.

A similar presentation is reported in a twelve-year old boy who presented as a paediatric emergency with a polypoidal mass filling the oral cavity and reaching as far as the incisors.1 In our case, the mass was hanging out of the oral cavity and was 14 cm in length, 5 cm in diameter with a stalk of 4 cms in length. Upon reviewing the literature, we did not find any report similar to our case with regard to the size of the mass.3,4 The tendency of polyps to grow in a particular pattern can be seen from the past history of similar presentation eight years ago. The increasing size and weight of the mass can cause its autoamputation, thereby causing stridor, which can prove fatal in such presentations.2 In the case of our patient, self-neglect and the delay in presentation led to such life threatening complication. Though antrochoanal polyp is a common occurrence, the seriousness of the condition is sometimes underestimated. The above presentation is rare and for this reason we believe the case will be of interest.