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Resection of the parapharyngeal space is often challenging. This study aims to evaluate the outcome of the endoscopy-assisted transoral approach for resection of the parapharyngeal space tumors compared with the endoscopy-assisted transcervical approach.Twenty-three consecutive patients (15 males, 8 females) who underwent resection of large parapharyngeal space tumors via endoscopy-assisted transoral (ETO) approach or endoscopy-assisted transcervical minimal incision plus osteotomy of the vertical ramus outside the mandibular foramen (ETC + MO) approach were analyzed retrospectively.The tumors in ETO group are benign; there are 2 patients with adenoid cystic carcinoma and 1 patient with recurrent pleomorphic adenoma in ETC + MO group. All of the tumors were removed completely and without rupture. No major complications developed in any patient. Temporary facial paresis occurred in 1 patient in the ETC + MO group, which resolved spontaneously within 8 weeks. The cosmetic effects of all patients in ETO groups and 10 patients in ETC + MO groups were excellent. Patients were followed up for 7 to 26 months, no recurrence was encountered.ETO and ETC + MO approach in resection of large parapharyngeal space tumors are feasible and safe technique that achieve excellent aesthetic and functional results. Endoscopy-assisted transoral approach can shorten hospitalized time and avoid the risk of marginal mandibular nerve injury and ETC + MO approach may be used in malignant or recurrent parapharyngeal space tumors.