Postoperative dietary management after parotid gland surgery in the absence of high-level evidence: consensus-based guidelines and a stepwise protocol for diet advancement.

Background: Despite the ubiquity of dietary advice after parotid surgery, no structured or evidence graded guideline has previously addressed its rationale, timing, or impact on salivary complications. The assumption that "some form of diet is always needed" has persisted largely unchallenged, with heterogeneous habits replacing data driven recommendations. Methods: An expert panel conducted a structured consensus process informed by systematic reviews of sialocele and salivary fistula prevention, contemporary parotidectomy series, and ERAS based nutritional frameworks for head and neck surgery. Using GRADE methodology and the ESGS/EMSGS anatomical classification, the group developed a surgery stratified, time based dietary advancement protocol. Results: The proposed algorithm defines decision nodes at postoperative days 0-1, 2-7, week 2, and weeks 3-4, linking dietary texture progression to wound appearance, swelling, pain, and any signs of salivary leakage. The protocol translates subjective, experience based decisions into reproducible criteria adaptable to varied resection extents and patient risk profiles. Recommendations emphasise individualized advancement from low sialagogue, soft regimens toward normal texture as recovery permits. Conclusions: Standardizing dietary management after parotidectomy reframes nutrition as a modifiable factor in reducing salivary complications while fostering patient understanding and adherence. The consensus highlights the value of early dietitian involvement, clear food lists, and education on mechanical load and salivary stimulation. By codifying a traditionally empirical aspect of care, these guidelines offer clinicians an immediately applicable framework and delineate research priorities for future prospective validation of evidence based dietary care following parotid surgery.