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Background: To study the endoscopic trans-lateral molar (ETLM) approach to infratemporal fossa (ITF) lesions and analyze the advantages and disadvantages of this method. Methods: Four cases of ITF lesions were analyzed retrospectively. The clinical features, diagnosis and treatments, the operative process, and clinical applications of this surgical approach were discussed. Results: Postoperative pathologies were 2 pleomorphic adenomas, 1 schwannoma, and 1 inflammatory lesion. All patients had self-resolving cheek swelling and pharyngalgia in the short term, but 2 patients had numbness in the long term. There was no infection or bleeding in the postoperative period, and no difficulty in chewing after disease recovery. There was no tumor recurrence during the follow-up period. Conclusion: The ETLM approach is convenient, minimally invasive, and allows complete excision of benign ITF lesions, posterior to the lateral pterygoid muscle and mainly below the level of the hard palate. It is a simple and direct access to the ITF, but it is a narrow access because of the limitations of bones and soft tissues. Appropriate patient selection is mandatory for successful surgery. [ABSTRACT FROM AUTHOR]