Objectives: Evaluate the efficacy and outcome of the maxillary swing approach for management of extensive nasopharyngeal angiofibromas. Methods: Retrospective analysis in a tertiary care center revealed 5 patients with extensive nasal angiofibromas operated on using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to lateralmost portions of infratemporal fossa with complete occupation, destruction of lateral wall of sphenoid sinus causing abutment to cavernous sinus, and complete involvement of pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of maxillary sinus in consequence to erosion of posterior and medial walls of maxillary sinus, with another causing severe temporal lobe compression through roof of infratemporal fossa. All patients underwent tumor excision with the maxillary swing approach. Patients were followed up for a minimum period of one year after surgery. Results: The maxillary swing resulted in an optimal exposure of the entire central skull base including the infratemporal fossa and its far lateral and superior aspects. An adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.1 hrs. Postoperative healing was satisfactory with palatal fistula formation in 2 cases with all patients remaining disease free till present. One had minimal misalignment of the halves of upper jaw and two had epiphora, of which one required dacryocystorhinostomy. Conclusions: The maxillary swing is an effective approach in management of extensive nasopharyngeal angiofibromas and leads to an optimal anatomical exposure with minimal morbidity.