The anatomy of the parapharyngeal space is described and experience with 23 patients with parapharyngeal tumours seen over a 10-year period is reported. Despite reaching a large size, these tumours may be relatively asymptomatic, or be discovered incidently. CT scan, MRI, arteriography and fine needle aspiration are useful in establishing a diagnosis. The most common histological type (13/23 patients) was pleomorphic adenoma and these tumours were managed by transoral removal if small, or a combined transoral-external approach if large. No patient required a mandibulotomy for access and no benign tumour recurred. The outcome was poor in the 5 patients with malignant tumours and a more radical approach, midline mandibulotomy, should be considered if malignancy is suspected.