<p>Foreign bodies within the paranasal sinuses are rare, with approximately 70% of cases resulting from maxillofacial trauma. Retained bullets in the paranasal sinuses typically do not present an immediate risk, but they can lead to long-term complications, including chronic sinusitis, rhinolith formation, and meningitis. This case report discusses a 62-year-old male who presented with a gunshot wound to the right temporal region, which resulted in retained bullet in the sphenoid sinus and associated fractures. The patient was hemodynamically stable with a Glasgow Coma Scale of 15. CT imaging revealed a metallic foreign body in the left sphenoid sinus with comminuted fractures of the right orbit and sphenoid wall, along with periorbital hematoma. Management involved endoscopic sinus surgery, which allowed for the successful removal of the bullet using a transnasal transseptal approach under general anaesthesia. The bullet was found to be in proximity to critical structures, including the internal carotid artery, but no complications such as bleeding or cerebrospinal fluid (CSF) leakage occurred. The patient had an uneventful postoperative course and was discharged on the fifth day, with no follow-up issues. In patients with retained bullets in the paranasal sinuses, management is primarily guided by the severity of associated injuries. While the removal of retained bullets can often be performed electively, early removal is recommended to minimize the risk of complications. Advanced imaging and endoscopic techniques have significantly improved the accuracy and safety of foreign body removal, reducing morbidity and achieving favourable outcomes.</p>