Objective To analyze the therapeutic effect and influence of two different methods of endoscopic treatment via oral vestibule approach or areola approach on patients with papillary thyroid carcinoma. Methods The clinical data of 130 patients with papillary thyroid carcinoma admitted to the hospital were collected between January 2019 and February 2021, and the patients divided into oral group (endoscopic papillary thyroid carcinoma surgery via oral vestibule approach, 66 cases) and areola group (endoscopic papillary thyroid carcinoma surgery via areola approach, 64 cases) according to two different endoscopic approaches. The lymph node dissection, Visual Analogue Scale (VAS) pain score immediately after surgery, at 12 h after surgery, 24 h after surgery and 48 h after surgery, surgery-related indicators (surgical time, blood loss, hospital stay) and incidence rates of postoperative complications (postoperative hemorrhage, recurrent laryngeal nerve injury, infection, etc.) as well as scores of Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) after surgery were compared between the two groups. Results In terms of lymph node dissection status, there was no significant change in the number of lymph node dissections in the paratracheal esophagus and anterior larynx in the two groups (P＞0.05). The number and duration of lymph node dissection in central region of oral group were significantly less or shorter than those in areola group (P＜0.01). There was no significant difference in pain VAS score between the two groups immediately after surgery (P＞0.05). The longer the postoperative time, the lower the pain score of oral group than areola group (P＜0.01). As for surgical indicators and occurrence of complications, there were no statistical differences in surgery-related indicators and occurrence of postoperative complications between the two groups (P＞0.05). The scores of VSS scale and observer scar assessment scale (OSAS) of POSAS scale of oral group were significantly decreased compared with those in areola group (P＜0.01). Conclusion Endoscopic treatment via oral vestibule approach for papillary thyroid carcinoma has more central lymph node dissections, shorter surgical time and better aesthetics than endoscopic treatment via areola approach, but there are no significant differences in postoperative pain, surgery-related indicators and complications between the two approaches.