Pleomorphic adenomas are the most common tumors of the parapharyngeal space (PPS) and often grow to an enormous size before becoming visible or symptomatic. CT and MRI scans are important in both diagnosis and surgical treatment. There are basically four different surgical approaches (transoral-transpalatal, transcervical-submandibular, transparotid und transmandibular) to the anterior PPS. Wide and direct exposure of the PPS is provided by a midline mandibulotomy with transection of the floor of the mouth. Owing to its morbidity this approach is reserved exclusively for extended tumors. The transcervical-submandibular route with blunt finger dissection generally offers adequate access for total tumor removal. For adenomas arising from the parotid gland a transparotid approach may be utilized. Adenomas located medially are better be resected transorally by splitting the soft palate.