Sarcoidosis is a systemic disease of unknown origin that is characterized by noncaseating granulomatous lesions. Primary otolaryngologic manifestations of sarcoidosis are not commonly seen. The documented incidence of parotid gland involvement (either primary or secondary) is only 6%. Extrapulmonary involvement can be present in up to 30% of patients with sarcoidosis and can present at the same time as pulmonary sarcoidosis. We report a case involving a patient with primary unilateral parotid sarcoidosis who returned with bilateral recurrence approximately 4 years after a total unilateral parotidectomy. To the best of our knowledge, this is only the second reported case in the English-language literature of primary parotid sarcoidosis that is the sole manifestation of the disease. We also discuss methods of diagnosis and treatment of head and neck manifestations of sarcoidosis.