Objective To compare the efficacy of traditional transcervical approach, endoscopy-assisted transcervical approach and endoscopy-assisted transoral approach for resection of benign parapharyngeal space tumors.Methods Clinical data of 159 patients with primary benign parapharyngeal space tumors admitted to the department of otolaryngology and head and neck surgery, xiangya hospital, central south university from January 2013 to May 2023 were retrospectively analyzed. All the patients received one of the three surgical methods: traditional transcervical, endoscopy-assisted transcervical, and endoscopy-assisted transoral. One-way ANOVA and Chi-square test were used to compare the surgical outcomes and prognosis. Results There were insignificant differences in intraoperative blood loss (F=2.64, P=0.074), retention time of postoperative drainage tube (F=2.44, P=0.091), drainage volume (F=2.88, P=0.060) and discharge time (F=0.77, P=0.464) among the three groups. Compared with endoscopy-assisted transcervical approach and traditional transcervical approach, endoscopy-assisted transoral approach had shorter operation time (F=10.70, P<0.001), and lower incidence of postoperative complications (χ²=9.426, P=0.009).Conclusions The three surgical approaches used in this study are safe and feasible, capable of completely removing tumors whiles ensuring a lower incidence of complications. Compared with endoscopy-assisted transcervical and traditional transcervical approach, endoscopy-assisted transoral approach has less trauma, shorter operation time and lower incidence of postoperative complications. However, endoscopic operation is more difficult with more strict indications. Therefore, it is necessary to flexibly select the surgical approach according to the symptoms, signs, nature and imaging characteristics of the tumor, so as to achieve the best benefit for patients.