Parotid sialolithiasis may pose relevant surgical challenges, particularly when sialoliths are deeply located, non-palpable, and intraoperative localization is uncertain, potentially requiring extensive parenchymal dissection. This technical note describes a neuronavigation-guided targeted open approach for parotid sialolith removal applied in three selected patients with parotid sialolithiasis refractory to previous treatments. Preoperative computed tomography was used for surgical planning and intraoperative navigation, allowing precise sialolith localization and focused dissection through a limited open access, in combination with intraoperative facial nerve monitoring. After sialolith removal, intraoperative cone-beam computed tomography was performed to confirm complete extraction and exclude residual fragments. No intraoperative or postoperative complications were observed, and parotid gland function was preserved in all cases. Neuronavigation-assisted targeted open surgery, combined with intraoperative imaging verification, may represent a valuable option in selected cases of parotid sialolithiasis, improving surgical accuracy and intraoperative confidence.