Nasopharyngeal carcinoma is a unique tumour which is endemic in southern China including Hong Kong. Whilst the treatment results for the primary cancer has been encouraging, management of recurrent tumours has been challenging. Compared to other surgical approaches, the maxillary swing operation provides wide access to the bilateral nasopharynx and the ipsilateral parapharyngeal space, allowing resection of tumours with adequate margins. Among the 312 patients who had received salvage nasopharyngectomy via the maxillary swing approach, the chance of achieving microscopically clear resection margins was 79.5 %. The overall local recurrence rate after surgery was 13.1 %. Multivariate analysis showed that resection margin status, synchronous nodal recurrence and cavernous sinus invasion were independent prognostic factors for overall survival. For small tumours located in the posterior wall, endoscopic resection, or more recently, the transoral robotic (TORS)-assisted approach, can be performed. Every effort should be made to ensure microscopic clearance of disease as well as to minimize the potential complications of surgery that may adversely affect the subsequent quality of life.