Sinonasal cancers are rare and aggressive, accounting for 3% of all head and neck malignancies and <1% of all malignancies. The clinical presentation can be highly
nonspecific, making an early diagnosis quite challenging. Typical symptoms, including nasal obstruction, rhinorrhea, and epistaxis, are usually indistinguishable from benign diseases. Advanced manifestations, such as headache, visual disturbance, facial pain, and trismus, arise as a result of structural invasion by the tumor. The prognosis can be frustrating due to the delayed diagnosis and the rapidly invasive manifestation. Here, we report a case of a 60-year-old man who presented with persistent facial pain for months and was evaluated by multiple specialists (neurologists, dentists, and otorhinolaryngologists). After thorough examinations, he was ultimately diagnosed with undifferentiated sinonasal carcinoma. Physicians should keep sinonasal undifferentiate carcinoma in mind when noticing persistent unexplained facial pain. We have provided a comprehensive diagnostic algorithm (Figure 2) for patients with an initial presentation of facial pain. Appropriate referral to specific departments could allow earlier diagnostic and therapeutic approaches, which may lead to a better prognosis. (J Taiwan Otolaryngol Head Neck Surg 2023; 58:215-222)
