Adenoid cystic carcinoma (ACC) is rare. One of its characteristics is a high rate of distant metastasis, and the most common site is the lungs, followed by the brain and liver. Bony metastases account for up to 1.96% of cases only, however, and metastasis from the blood to the bones of distal limbs is rare. We report a 62-year-old woman who presented with pain caused by bony metastases as the first symptom eight years after being diagnosed with submandibular ACC. Although such cases are rare, they indicate that when patients who have had cancer visit the hospital with other symptoms, clinicians should make sure to rule out metastasis. (C) 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.