Aims: Acinic cell carcinoma (AciCC) of the parotid gland is a rare malignancy of major salivary glands. While parotidectomy is the standard treatment, the role of elective neck dissection (END) in the clinically node-negative (cN0) neck remains controversial. Variability in clinical practice reflects the lack of consensus on whether END improves outcomes by addressing potential occult lymph node metastases (OLNM). Methods: This review was conducted per PRISMA-ScR. Comprehensive searches of PubMed, EMBASE, and CINAHL were conducted up to May 2025. A rigorous screening process was conducted by two independent reviewers and discrepancies resolved by a third. Eligible studies included randomised, controlled, and cohort designs that reported outcomes for END in cN0 parotid AciCC. Data extraction focused primarily on survival outcomes, recurrence and occult lymph node metastasis. Quality and risk of bias was assessed using the Newcastle–Ottawa Scale. Results: A total of 741 articles published between 1993 and 2025 were screened, with 13 retrospective cohort studies meeting the inclusion criteria. Across 2,646 parotid AciCC cases, 788 patients underwent END, of which 77 demonstrated OLNM. Marked heterogeneity was observed among studies, with reported OLNM rates ranging from 0% to 37.5% and a weighted mean of 9.9%. Stratified analyses indicated that nodal involvement was more common in high- and intermediate-grade tumours (46.8%) than in low-grade tumours (15.2%). Similarly, advanced T-stage (T3–T4) tumours showed higher OLNM rates (18.2%) compared with early-stage (T1–T2) tumours (7.3%). Conclusion: Evidence does not support routine END in low-grade, early-stage AciCC, where survival after local excision is generally excellent. By contrast, high-grade transformation and advanced T-stage are consistently associated with poorer survival, recurrence, and metastatic risk, suggesting a possible role for END in selected high-risk patients.