Background: Carpal Tunnel Syndrome (CTS) represents the most prevalent peripheral neuropathy in clinical settings, comprising approximately 90% of all entrapment neuropathies. This study aimed to evaluate the effectiveness of the extended open release compared to the mini-open technique in managing CTS. Material and methods: This retrospective case series reviewed sixty patients diagnosed with severe CTS via electrodiagnostic tests and grip strength analysis. These patients were evenly divided into two groups: Group A (GA) underwent an extended open carpal tunnel release with an incision extending proximal to the wrist flexion crease, and Group B (GB) underwent a mini-open carpal tunnel release (2-3 cm). Follow-up periods were set at six months and one year, with evaluations focusing on return to work, cosmetic outcomes using the Vancouver Scar Scale (VSS), responses to the Boston Carpal Tunnel Questionnaire (BCTQ), and overall patient satisfaction. Results: At the six-month follow-up, GA's mean symptom severity score (SSS) was 14.766±3.147, compared to 12±3.102 for GB. After one year, these scores changed to 12.666±8.921 for GA and 11.5±5.339 for GB, with the differences proving statistically significant (P≤0.001) at both intervals. Functional severity scores (FSS) also showed significant differences at the six-month checkpoint, with scores of 10.866±8.951 for GA and 9.733±4.668 for GB (P≤0.03). Conclusions: The use of the mini-open approach was found to be better in terms of symptoms and functional improvement, patients’ satisfaction, and cosmesis as compared to the extended open approach. However, grip strength measurements after one year showed comparable results between the two groups.