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Introduction/Purpose Endovascular embolization is a critical intervention for managing acute hemorrhage associated with cancers of the head and neck. However, delayed complications related to embolic materials are rare and not well described. This report describes a rare case of delayed transoral extrusion of embolization coils following embolization for hemorrhage in a patient with tonsillar squamous cell carcinoma.Materials and Methods A 45-year-old male with a history of right tonsillar squamous cell carcinoma status post chemoradiation presented with sentinel oral bleeding. Initial CTA demonstrated post-radiation changes without active extravasation. Given high risk of re-hemorrhage, prophylactic embolization of the involved arteries was requested. The patient underwent diagnostic angiography followed by embolization of the right facial artery using six coils and Onyx-18 and lingual artery with Onyx-18 alone via a transradial approach. Post-embolization angiography demonstrated successful occlusion with no evidence of non-target embolization or complications.Results The patient remained clinically stable until approximately four months later, when he re-presented with coil material hanging from the oral cavity. The patient reported two prior episodes of coil material that he had removed himself without bleeding. Facial radiographs corroborated coil extension through the inferolateral right oral cavity. CT angiography confirmed an embolization coil in the right glossotonsillar recess surrounded by air, without associated hemorrhage or vascular injury. On presentation, one coil was found extruding transorally, the protruding coil was removed at bedside by ENT due to discomfort. Subsequent diagnostic angiography demonstrated complete occlusion of the previously embolized right facial and lingual arteries, with no evidence of active extravasation, pseudoaneurysm, or revascularization.Conclusion Delayed transoral extrusion of embolization coils is a rare but important potential complication in patients with head and neck malignancies, particularly in the setting of prior radiation and tissue necrosis . We propose that progressive tumor necrosis and post-radiation tissue breakdown facilitated coil migration through the soft tissues into the oropharynx. Despite the extrusion of the coils, the vascular occlusion remained intact, likely supported by the concurrent use of Onyx. Clinicians should be aware of this delayed complication in irradiated patients with head and neck malignancies who undergo endovascular embolization.Disclosures U. Verma: None. H. Shakir: None.Abstract E-037 Figure 1