Objectives To study the clinical value of ultrasound-guided percutaneous microwave ablation (MWA) in benign parotid tumors. Methods Eighteen patients with benign parotid tumors who were treated with ultrasound-guided MWA between January 2020 to March 2023 were included in this retrospective study. Changes in tumor longest diameter, tumor volume, volume reduction rate(VRR), and cosmetic score(CS) were evaluated during the follow-up time. Evaluate complications associated with MWA at the same time. Result A total of 18 patients (11 males and 7 females, median age 63.2±17.2) were included in the study. The mean VRR of 1, 3, 6, and 12 months after MWA had reached 0.37%±0.12%, 0.57%±0.10 %, 0.81%±0.09 % and 0.90%±0.07%, respectively. Mean CS also changed from 3.28±0.67 to 1.75±0.93 (P＜0.001) at the end of follow-up time. Subgroup analysis showed that those tumors with smaller initial longest diameters had a faster CS reduction rate. Conclusion The results of this study demonstrated that ultrasound-guided percutaneous MWA has good clinical effects, and early intervention for patients can achieve better cosmetic results.