Objective: Parathyroidectomy is a procedure best performed by experienced parathyroid surgeons. Ectopic parathyroid adenoma is a well-described entity that can lead to a failed parathyroidectomy. Parathyroid adenoma of the piriform sinus is especially rare. Methods: Herein, we present a case series of 2 patients with ectopic parathyroid adenoma of the piriform sinus who underwent transoral resection of the lesion. Results: Both patients were successfully treated in our case series, and enjoyed an appropriate return to normal calcium and parathyroid levels. We further highlight the embryologic basis for this entity and present the available literature regarding surgical extirpation of parathyroid adenoma of the piriform sinus. Conclusion: Herein, we describe a transoral approach to piriform sinus adenomas in 2 patients. Both procedures were successful and without sequelae. We further provide a brief discussion of the management of other known cases of piriform sinus adenoma as well as their embryologic underpinnings.