We present what to the best of our knowledge is only the fourth case of a primary nasopharyngeal paraganglioma to be reported in the literature, and we describe a novel surgical approach to its removal. The patient was a 53-year-old woman who presented with a nasopharyngeal mass. A subtotal resection and biopsy of the mass identified it as a paraganglioma. The remainder of the tumor was completely excised via a combined transnasal endoscopic and transoral approach that allowed us to spare the palate. The total operating time was less than 90 minutes. Blood loss was estimated at 300 ml, and there were no intraoperative or postoperative complications. At follow-up 12 months later, endoscopic examination and imaging found no residual or recurrent tumor.