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A 57-year-old woman presented to our department with a 2-month history of pain and paresthesia on the left side of the face 12 years after having undergone surgery for breast cancer. We performed an endoscopic biopsy and diagnosed metastatic breast cancer to the pterygopalatine fossa. There has been no recurrence for two years since the metastatic tumor was treated by radiation therapy. A literature search shows only one case of metastatic breast cancer with severe trigeminal neuralgia located in the V2 division of the trigeminal nerve area. Metastatic disease should be considered part of the differential diagnosis in patients presenting with trigeminal neuropathy.