Background: Metastasis of breast carcinoma to the paranasal sinus is rare. There is hardly any accumulated data to guide therapy and counseling. Methods and results: We report two cases and performed a systematic review. To date, 40 other cases have been reported since 1939 with a median survival of only 6 months after first presentation. The median time between diagnosis of the primary tumor and discovery of the paranasal metastasis was 33 months. Only nine cases of solitary paranasal sinus metastasis could be identified, having the same poor prognosis. Overall, no indicators could be found for a better prognosis, not even the type of treatment (if any). Conclusions: Paranasal metastases of breast carcinoma are rare but lethal. Treatment should be aimed at palliation only. Extra care should be taken when patients with a history of breast cancer present with complaints of headaches, facial pain, visual impairment or (unilateral) nasal obstruction.