Adenoid Cystic Carcinoma (ACC) of sinonasal tract is a very rare, slow growing malignant tumour comprising less than 1% of head and neck cancers. It’s presentation with non-specific symptoms at an advanced stage of tumour and proximity to important structures such as brain and cranial nerves, limits the management options intended for curative approach. A combination of surgery followed by adjuvant radiotherapy is the current choice of treatment. We describe a case of Sinonasal ACC originating from left Sphenoid sinus presenting with an isolated symptom of epistaxis in a 71-year-old female who was managed with the combination approach.