Twenty patients with neoplasms originating in the nasopharynx were operated using the infratemporal fossa approach with facial translocation (15 cases), the subtemporal-preauricular infratemporal approach (2 cases), and the transmandibular approach (3 cases). A craniectomy was also required in 14 cases. Fifteen tumors were malignant, while 5 were juvenile angiofibromas with infratemporal and intracranial extensions. Most of the lesions were large and involved multiple areas of the skull base. Tumor excision was total in all but 3 patients. Local flaps were utilized in all patients to seal the operative cavity and consisted of temporalis muscle flaps. The most frequent postoperative complications were wound infections and cerebrospinal leaks. Two patients died as a result of postoperative complications. To date, 1 patient has died from disease and 3 are alive with local or distant disease.