Aims: A parotid mass with facial palsy classically signals malignancy. We illustrate the diagnostic pitfalls of infarcted Warthin tumor mimicking carcinoma, delineate mechanisms of associated nerve palsy, and evaluate surgical outcomes. Methodology: We report a case of infarcted Warthin tumor with facial palsy and conduct a structured review of PubMed and CENTRAL databases, analyzing clinical presentation, cytopathology, management, and functional outcomes. Results: A 59-year-old male smoker developed acute left facial palsy initially managed as Bell’s palsy. A parotid mass emerged six weeks later. MRI suggested neural involvement, and fine-needle aspiration (FNA) yielded a salivary neoplasm of uncertain malignant potential. Following acute pain, repeat aspiration suggested an infarcted Warthin tumor. At total parotidectomy, the mass was inseparable from a non-stimulable nerve division, requiring sacrifice and immediate grafting. Histology confirmed a benign, extensively infarcted Warthin tumor. The review identified 12 additional cases (n=13). The primary clinical presentation (61%) was a long-standing mass followed by acute enlargement and nerve palsy, often painful and occasionally following FNA. Preoperative FNA failed to diagnose Warthin tumor in 100% of cases, with 37.5% falsely suggesting malignancy. Histopathology typically demonstrated infarction and squamous metaplasia, with secondary fibrosis, inflammation, or infection. Nerve sacrifice was performed in 60% of cases, yet only half showed true intraoperative involvement; most nerves were merely compressed. Sacrifice yielded poor functional outcomes; nerve preservation led to favorable recovery. Conclusion:  Infarcted Warthin tumour can closely mimic malignancy through the convergence of facial palsy, indeterminate cytology, and suspicious imaging findings. If the nerve is anatomically intact intraoperatively, preservation should be prioritized over aggressive sacrifice. Preoperative core needle biopsy should be considered to prevent overtreatment.