Surgical approaches in parapharyngeal and retropharyngeal spaces can be challenging. Diverse approaches, including transoral, transcervical, transparotid, or transmandibular approaches, can be considered. Even with meticulous dissection, various neurological complications can occur in these areas, such as first bite syndrome and injury to the vagus nerve, hypoglossal nerve, sympathetic nerve trunk, and/or marginal mandibular nerve. Neurological complications following parapharyngeal or retropharyngeal space operations can affect the patient’s quality of life by compromising swallowing and vocal functions. To prevent these complications, the selection of an optimal approach that allows good visual access to the tumor and surrounding structures is paramount. Most symptoms from complications improve with rehabilitation and time. However, some may necessitate secondary operations, and some may be fatal.