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Pyogenic granuloma gravidarum occurs as oral or nasal lesions in approximately 5% of pregnant women. Nasal mucosa is an unusual site for this lesion with few cases reported in the literature. A case of giant nasal pyogenic granuloma gravidarum that required radical excision through an open rhinotomy after superselective embolization is described. The patient had a good cosmetic result and a satisfactory airway when she was seen for follow-up 1 year after surgery. Giant pyogenic granuloma gravidarum is best managed with a multidisciplinary approach involving radical excision after preoperative superselective embolization for safe and complete removal of the lesion.