Recurrent primary nasopharyngeal carcinoma after radiotherapy exhibits wide local extension [Uttley D, Moore A, Archer DJ. J Neurosurg 1989;71:705-10]. This wide exposure of the nasopharynx and its vicinity is essential for an oncological radical resection to be carried out. The resection should embrace the tumor with an adequate mucosal margin including the cartilaginous portion of the Eustachian tube. Paranasopharyngeal tissues should be included in the resection whenever indicated. The anterolateral approach to the nasopharynx and the paranasopharyngeal space provides adequate exposure required for an oncological resection. Morbidity associated with the operation is low and this is recommended for resection of most recurrent primary nasopharyngeal carcinoma after radiotherapy.