We present a transoral approach using image guidance to approach inferiorly based lesions of the pterygopalatine fossa. Case report. A 49-year-old male presenting with a benign cyst of the inferior pterygopalatine fossa. The presentation, workup, and management are discussed. The patient underwent a computed tomography scan that confirmed the location of the lesion in the left pterygopalatine fossa. An image guidance system was used to effect a complete transoral resection of the benign cyst. Benign lesions of the pterygopalatine fossa may be successfully accessed using a transoral approach with image guidance, which minimizes postoperative morbidity.