Nasopharyngeal angiofibroma (NA) is a benign mesenchymal tumor that usually occurs in adolescent males, and rarely affects middle-aged patients. We report a case of NA in a middle-aged man with a mental disorder who presented with airway obstruction that required emergency tracheostomy. Our patient had difficulty in communicating his complaints because he had suffered from schizophrenia from his adolescent years, so that the tumor had remained unrecognized until it had grown to a huge size. Endoscopy-assisted transoral resection was performed to resect the tumor. The tumor was a pedunculated lesion whose base arose from the right side of the nasopharynx, and was removed completely without major bleeding. There has been no recurrence so far. The present case indicates that NA needs to be included in the differential diagnosis of airway obstruction, especially in patients with communication difficulties caused by mental disorders.
