Intraoperative nerve monitoring (IONM) is essential in parotid surgery to safeguard the facial nerve and prevent postoperative complications. This study reviews the efficacy and techniques of IONM during parotidectomies. Initially introduced in the 1960s, IONM has evolved significantly, with electromyography (EMG) becoming a standard practice by the early 1990s. The primary role of IONM is to provide real-time feedback on the functional integrity of the facial nerve through visualization and acoustic signals, thereby reducing the risk of irreversible nerve damage. This technique involves a multidisciplinary team comprising the surgeon, IONM technician, anesthesiologist, and neurophysiologist, each playing a crucial role in ensuring patient safety and optimal surgical outcomes. Studies indicate that the use of IONM significantly reduces the incidence of transient facial nerve paralysis (TFNP) compared to unmonitored procedures, although its impact on permanent facial nerve paralysis remains inconclusive. Advanced IONM devices enable precise monitoring by recording compound muscle action potentials (CMAPs) in response to nerve stimulation, thus aiding in the accurate identification and preservation of the facial nerve during tumor dissection. Despite mixed results regarding its effectiveness in reducing facial nerve injury in benign tumor surgeries, IONM remains a valuable tool in complex and revision parotidectomies, where it contributes to shorter operative times and improved nerve function recovery. This review underscores the importance of IONM as an adjunct to anatomical knowledge and surgical expertise, advocating for its continued use to enhance the safety and efficacy of parotid surgeries.