An unusual case of penetrating maxillofacial injury caused by a nail gun is presented. In this case, the foreign body was shot into the left infratemporal fossa and maxillary sinus through the left cheek. We used an intraoral approach that allowed precise localization of the point of the infratemporal surface of the maxilla through which the nail penetrated the maxillary sinus. The nail was successfully removed and the patient was discharged with complete recovery. The details of the surgical approach as well as localization techniques are described. Different approaches to remove the nail as well as the advantages and disadvantages of each approach are discussed.