Carcinoma of the parotid gland accounts for 14–25% of all parotid lesions. 14–30% patients present with no clinical indications of an advanced tumor until discovery of FN weakness/paresis during the preoperative exam or a nerve invasion during surgery. It is commonly accepted that patients with preoperative total paralysis of the FN are not candidates for preservation. Additionally, in cases of weakness or selectively compromised FN branches, attempts should be made to preserve the trunk and the non-compromised branches. In at least a third of patients without preoperative FN paralysis, an intraoperative finding obligated the sacrifice of the FN. The belief that postoperative radiotherapy can control positive microscopic margins in cases of FN preservation is not supported by evidence. Approximately 25–33% patients have moderately functional sequelae even after FN sacrifice. An immediate reconstruction with nerve free graft improves functional recovery and should be attempted.