Aims To determine in patients with clinical and radiological N0 necks in primary parotid carcinoma: 1.) Rate of occult node positivity post-neck dissection 2.) Outcomes following elective neck dissection +/- radiotherapy. 3.) Factors predicting recurrence and mortality following treatment. Methods A retrospective study on patients diagnosed with malignant neoplasm of the parotid between 01/2007 – 12/2018 from 3 UK tertiary centres. Results 134 patients were identified. 6% (4/62) of patients who underwent neck dissection for radiologically N0 neck had positive lymph nodes. There was no statistically significant feature associated with recurrence and disease-related mortality, but recurrence was associated with an increased risk of mortality (HR 1.444). Conclusion This study has demonstrated a low rate of occult nodal disease in N0 parotid malignancy and suggests that high-grade disease has a higher risk of nodal disease and recurrence. These patients may benefit from elective neck treatment, but more prospective data is required.