Patients with head and neck cancer face unique challenges in maintaining adequate nutrition. Both the disease itself and the treatments, especially surgery and radiation therapy, have signifcant negative impact on upper digestive tract function, and oral intake is often insuffcient during and after therapy. Placement of gastrostomy tubes is the most common approach to ensuring safe delivery of adequate nutrition, but the optimal timing remains unclear. Prophylactic (pretreatment) gastrostomy tube placement is commonplace, but there is a lack of evidence to support this practice for all patients. Much work has been done with respect to improvement of functional recovery from dysphagia, which includes rigorous "exercise" programs that show great promise. A diverse and experienced patient care team is needed to produce the best outcomes.