Proper nutritional management has assumed an increasingly important role in the care of cancer patients in recent years. Head and neck cancer creates disturbances in host nutritional balances. Profound nutritional depletion and cachexia are induced by local and distant effects of head and neck carcinoma. Radiation, chemotherapy and surgery tend to compromise the host further by compounding these nutritional deficits. This paper reviews the factors responsible for the malnutrition associated with head and neck malignancy, and discusses the current methods available for identifying and following the nutritionally depleted patient.