Mega slug-like polyp and deviated septum. Can’t smell and can’t sleep!
The patient needs two operations. He has a large antrochoanal polyp running down the back of his nose and blocking the post nasal space of both sides. But to get it out by widening the accessory ostium enough to get instruments into the maxillary sinus, the deviated nasal septum needs correcting so that there is enough angle to do the endoscopic procedure.
Large arrow is the big yellow slug-like polyp.
Small arrow is the deviated nasal septu blocking the endoscopic approach.