Objective To explore the clinical features, surgical methods, and treatment outcomes of patients with parapharyngeal space tumors.Methods Clinical data of patients with parapharyngeal space tumors admitted to the First Affiliated Hospital of Nanjing Medical University from November 2012 to November 2022 were retrospectively analyzed. A total of 72 patients with complete imaging and follow-up data were screened out, including 36 males, aged 27-72 years old, with an average age of (46.06±1.72)years old and 36 females, ranging from 21 to 77 years old, with an average age of (53.67±4.88)years old. According to preoperative physical examination and imaging examination, the surgical plan was made for all patients, 27 cases by oral approach and 45 cases by cervical lateral approach. Postoperative follow-up lasted from 2 to 135.9 months, with a median of 54.38 months. Their clinical, imaging, and surgical data were statistically analyzed.Results Of the 72 patients, postoperative pathology confirmed benign tumors in 63 cases, including epithelial-derived tumors in 29, neurogenic tumors in 30, and tumors derived from other tissues in 4. Of them, 4 cases recurred, including 2 of schwannoma, 2 of pleomorphic adenoma, and 59 cases recovered well. There were 9 cases of malignant tumors, including 5 of squamous cell carcinoma, 1 of malignant spindle cell tumor, 1 of malignant lymphoma and 1 case of synovial sarcoma. And 3 cases of them relapsed. Despite intracapsular resection during oral endoscopic surgery for benign parapharyngeal space tumor, there was no increased risk of recurrence compared with en bloc endoscopic resection (P=0.381).Conclusions The parapharyngeal space tumor is deep in the location, the clinical structure is complex, the prognosis of benign tumors is reasonable, while the prognosis of malignant tumors is poor due to complicated pathological results. It is essential to determine the surgical approach according to preoperative physical examination and imaging examination. The primary surgical method is the open cervical approach, and the endoscopy-assisted approach needs to grasp the indications strictly. Intracapsular resection with an intact capsule is feasible when the tumor is large.