The management of malignant salivary gland neoplasms is based on a surgical paradigm, with intraoperative findings and pathology guiding the role of local-regional adjuvant therapy. Despite high rates of local control, local relapse can be a dominant pattern of recurrence, presenting therapeutic challenges. Although an optimal management approach has not been established, aggressive salvage surgery is favored given the morbidity associated with tumor progression at the skull base and the lack of significant response associated with other available treatment modalities. Postoperative radiotherapy has been demonstrated to be effective in the initial management of malignant salivary gland neoplasms and is generally favored for recurrent, surgically resectable tumors for the appropriate patient.