Aims: This study aimed to evaluate clinical outcomes and identify prognostic factors in patients with pulmonary oligometastases from head and neck squamous cell carcinoma (HNSCC). Methodology: This was a single-institution retrospective study. Seventy-seven patients with pulmonary oligometastases from HNSCC who underwent local therapy, including surgery or stereotactic body radiotherapy (SBRT), between September 2002 and July 2024 were included. Treatment eligibility was determined by a multidisciplinary team. Clinical variables, including disease-free interval (DFI), were collected. OS and PFS were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox proportional hazards models were used for univariable and multivariable analyses. Results: Fifty-four patients underwent surgery and 23 received SBRT. The median follow-up was 31 months. The 3-year OS and PFS rates were 68.3% and 41.9%, respectively. Multivariable analysis identified stage IV at initial diagnosis (HR 5.70, p=0.030) and DFI ≤6 months (HR 2.80, p=0.039) as independent poor prognostic factors for OS. DFI ≤6 months was also significantly associated with worse PFS (HR 2.45, p=0.017). Conclusion: Local therapy may be beneficial in selected patients with pulmonary oligometastases from HNSCC. DFI and clinical stage are important prognostic factors and may aid in treatment selection.