OBJECTIVE To study the diagnosis, treatment and the choice of operative entrance for parapharyngeal space neoplasm. METHODS In a retrospective study the data of 34 patients between 1993 and 2002 were analyzed with regard to presenting signs and symptoms, histological diagnosis, imaging technique and surgical approach. RESULTS 88.2% of the tumors were benign. Sixteen tumors originated from salivary glands. Neurogenic tumors were found in 14 patients. Thirty-four patients were treated surgically: the trans-cervical approach was used in 26 cases, trans-oral in 5 cases, the combined transoral-cervical approach in 2 cases, and trans-infratemporal fossa in 1 case. Thirty-two tumors were removed completely. The complications after operation were Horner syndrome (3 cases), vocal cord paralysis (5 cases) and facial nerve palsy (3 cases). One patient had both vocal cord paralysis and hypoglossal nerve paralysis. With the follow-up time of 13 months to 10.5 years, 30 patients had been cured, one patient turned to better, 3 cases had recurrence local tumour (pleomorphic adenoma). CONCLUSIONS The majority of tumors can be excised safely and completely using the trans-cervical approach. Intra-oral excisions should be indicated only for small tumors that tend to pharynx with clear border.