Aims: To describe a rare case of accessory parotid pleomorphic adenoma excised via a trans-oral, exoscopic-guided approach, and to outline the technical advantages and clinical outcomes of this method. Background: Accessory parotid gland (APG) tumours account for only 1–7% of parotid neoplasms. Pleomorphic adenoma in the APG is particularly uncommon and challenging due to its anterior cheek location, proximity to distal facial nerve branches, and the cosmetic impact of external incisions. Exoscopic visualisation, with high-definition magnification and heads-up ergonomics, offers a modern alternative to traditional open techniques. Methodology: A 57-year-old woman presented with a one-year history of a slowly enlarging left cheek mass. CT showed a well-defined 27 mm lesion arising from the anterior APG, with no cervical lymphadenopathy. Following cytological confirmation of pleomorphic adenoma, a trans-oral excision was selected to avoid external scarring. An exoscope provided magnified, high-resolution, hands-free visualisation during intra-oral dissection, allowing precise preservation of small facial nerve branches, careful mobilisation of the tumour, and controlled en-bloc removal through a concealed mucosal incision. Results: The tumour was excised fully with clear histological margins. No complications occurred, including no facial nerve weakness, ductal injury, or salivary fistula. The patient achieved an excellent cosmetic outcome with no visible scar and rapid recovery. Conclusion: Accessory parotid pleomorphic adenoma is rare and often treated through external cheek approaches. This case demonstrates that a trans-oral, exoscopic-guided technique provides enhanced illumination and magnification, enables safe dissection within a narrow operative corridor, preserves facial aesthetics, and delivers reliable oncologic clearance. It represents a valuable minimally invasive option for selected APG tumours.