Residual or recurrent nasopharyngeal carcinoma (NPC) is usually managed by re-irradiation or salvage surgery. This case presented a residual NPC with limited extent and an accessible location in the nasopharynx after completion of sequential chemoradiotherapy. The lesion was completely resected via the transpalatal route under endoscopic visualization with no significant post-operative morbidity. This is the first report of NPC successfully treated by this type of surgery.