OBJECTIVE To explore a reasonable surgical method for improving salvagy surgery of nasopharyngeal carcinoma (NPC). METHOD 25 cases of nasopharyngeal carcinoma with salvagy surgery were reviewed. Surgical accesses include the transcervico-mandibuio-palatal, the maxillary swing approach, the transpalatal approach for removing nasopharyngeal lesion. The pectoralis major muscle flap and galea aponeurotica flap were employed to repair operative defect and protect the critical structure of parapharyngeal space and the skull base. RESULT The operative complication rate is 16% (4/25), which are local infection and flap putrescence. The postoperative sequela such as cleft palate is slight. 18 cases were followed-up over 3 year and 8 cases died. 2 cases were lost. The 3-year survival rate is 44% (8/18). CONCLUSION The best operation access should be selected depending on the position and the implicated scope. Safely and fully removal of the tumor and reliably reconstruct are necessary. It is possible to improve salvage surgery effect for NPC patients.