Because accessory parotid gland tumors are relatively rare, no standard management method has been established yet. In this paper, we describe the surgical approach and usefulness of facial nerve monitoring in a patient with pleomorphic adenoma of the accessory parotid gland. The patient, a 61-year-old female, presented with a painless, hard mass on the left cheek. We performed surgical resection of the tumor by the peri-auricular-cervical flap approach. The buccal branch of the facial nerve was easily detected on the tumor by nerve integrity monitoring (NIM). No postoperative facial nerve palsy was observed. Histopathology of the resected tomor, which measured 23×17×18 mm in size, revealed that it was a pleomorphic adenoma. NIM was useful in the for safe resection of the accessory parotid gland tumor.
