The prognosis for patients suffering with parotid carcinoma is poor. One reason for this is the difficulty of eradicating the disease once cancer has spread to the bony parotid mould and to the ear. The anatomy of the parotid gland and the spread of malignant tumours are described with particular reference to the ear and parotid bed. Surgery is indicated if the tumour can be completely removed, and three cases are presented to illustrate radical parotidectomy achieved with the aid of temporal bone surgical techniques. When the facial nerve is sacrificed, immediate grafting offers the best chance of restoring satisfactory facial expression.