Background: Frontal sinus paragangliomas are rare neuroendocrine tumours in an unusual anatomical location. Surgical resection involving transorbital approach is particularly rare. Case Report: A 25-year-old male presented with pressure above the left eye on a background of pelvic paraganglioma resection in 2024. Imaging showed a tumour in the left frontal sinus involving the outer and inner table without intracranial extension. Biopsy confirmed paraganglioma. The patient underwent combined endoscopic frontal drill-out and transorbital excision in March 2025. The tumour was cleared macroscopically. Vision was preserved on follow-up review. A follow-up MRI is organised in December 2025. Discussion: Frontal sinus paragangliomas are extremely rare, with only isolated cases reported in the literature. Their proximity to critical structures such as the orbit and anterior skull base makes resection challenging. Multi-disciplinary consultation involving ENT, ophathlmology, neurosurgery and endocrinology was required in this case. Frontal sinus tumour is traditionally resected through FESS technique. The trans-orbital approach in this case was a rare and unusual technique for better access, which is also rarely performed in Australia. Conclusion: This case shows that paragangliomas involving the frontal sinus can be managed with a combined endoscopic and transorbital approach. ENT surgeons should always consider transorbital approach when FESS does not provide adequate access. Reference: 1. YAMAUCHI, T., KUBOTA, M., SAEKI, N., AIHARA, N., IWADATE, Y. and YAMAURA, A., 1999. Paraganglioma in the Frontal Skull Base—Case Report—. Neurologia medico-chirurgica, 39(4), pp.308-312. 2. Pellitteri, P.K., Rinaldo, A., Myssiorek, D., Jackson, C.G., Bradley, P.J., Devaney, K.O., Shaha, A.R., Netterville, J.L., Manni, J.J. and Ferlito, A., 2004. Paragangliomas of the head and neck. Oral oncology, 40(6), pp.563-575.