Adenoid cystic carcinoma (ACC) is a rare tumor comprising 1% of malignant tumors of head and neck . The most common localization for ACC is minor salivary glands and involvement of sphenoid sinus is very rare. It grows slowly and has a high tendency of local recurrence, and perineural invasion. Surgery and postoperative radiotherapy is considered as an optimal treatment. We present a case of 50-year-old female with complaint of nasal obstruction. The computed tomography imaging showed the presence of nasal mass arising from the posterior part of the nasal septum and the adjoining sphenoid sinus anterior wall. The mass was excised and the pathologic specimens revealed ACC with perineural invasion, positive surgical margin and bone destruction. The patient recieved postoperative radiotherapy. Improved treatment outcomes led the investigators to recommend the postoperative radiation as the routine treatment approach for most patients with the ACC of the head and neck to improve local control rates
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