Objective To explore the clinical diagnosis and surgical method for parotid pleomorphic adenoma, as well as the prevention and therapy of postoperative recurrence and complications. Methods Clinical data of 187 parotid pleomorphic adenoma cases were collected and analyzed, including 86 cases of partial parotidectomy (extra capsular resection of tumor), 72 case of subtotal parotidectomy with facial nerve preservation, and 29 cases of total parotidectomy with facial nerve preservation. Results After operation, 12 patients relapsed. No relapse occurred after the second operation. There were 20 transient facial nerve paralysis, 6 buccal branch′s facial paralysis, 10 marginal mandible branch′s facial paralysis, and 4 intermix facial paralysis. Treated with hormones, neurotrophy, and traditional Chinese physical medications, permanent facial nerve paralysis only remained in 2 cases, which lasted more than 6 months without complete recovery. In addition, parotid fistula appeared in 15 cases, and Frey′s syndromes were found in 36 cases. Conclusions The final diagnosis of parotid pleomorphic adenoma must rely on pathological examination. The best strategy is extracapsular resection combined with frozen pathology during the operation. The surgical method to remove the parotid pleomorphic adenoma should be chosen according to the size and position of the tumor, and the relationship between the tumor and facial nerve. The key point of surgery is anatomy of facial nerve, which can reduce the postoperative recurrence and complications.