Parotidectomy remains the standard of care and is recommended as the initial treatment for primary parotid gland malignancies, however, management of the neck remains controversial and studies are lacking that provide definitive evidence regarding the treatment of regional lymph nodes. Many studies have concluded that regional lymph nodes should be treated with either radiation therapy(RT) or neck dissection(ND) in high grade parotid cancers. To examine the overall survival of patients with high-grade parotid malignancies who received parotidectomy with neck dissection or both neck dissection and radiotherapy. A total of 1541 patients with high-grade primary parotid gland carcinoma were identified from the National Cancer Database (1998-2014). Cancer histologies included mucoepidermoid cancer (MEC) (42.6%), adenocarcinoma not otherwise specified (ANOS) (33.7%), adenoid cystic carcinoma (Ad Cy CA) (11.8%), and acinar cell carcinoma (AC CA) (11.8%). Treatment groups were composed parotidectomy + neck dissection (Group 1), and parotidectomy + ND + RT (Group 2). Regardless of histology, Group 2 had a higher survival than Group 1 in all histologies except Ad Cy CA, although not statistically significant. However, this relationship was not found when breaking down patients into clinically negative and positive disease. Group 1 had higher survival in cN0 MEC and Ad Cy CA patients whereas Group 2 had a higher survival in cN0 ANOS and AC CA patients. For cN+ patients, Group 2 had a higher survival in ANOS, but Group 1 had a higher survival in MEC and AC CA. Patients with high-grade parotid cancer appear to benefit from adjuvant RT to the neck. The pathologic findings found after neck dissection also appear to portend a worse prognosis. This study did not provide conclusive evidence to support either ND alone or RT alone to cervical lymph nodes although variations by histology and stage were evident.