While the primary goal of Head & Neck Cancer (HNC) treatment is oncologic control, increasing rates of survival and younger patients have highlighted long-term functional impairments after treatment. Patients may require additional surgeries to maintain quality of life. The role and frequency of therapeutic surgeries following definitive treatment for HNC, is not well described. A retrospective longitudinal cohort study included all HNC patients more than 18mths post-treatment referred to one multidisciplinary clinic between 2015-2024 (n=151, Mean=61yrs, male=70%). Patients with recurrent disease were excluded. Patients were stratified by treatment: Primary Surgical (n=38), Primary Chemoradiation (n=41), and Multi-Treatment (Surgery+adjuvant Chemoradiation) (n=72). Therapeutic surgeries were defined as surgeries to support functional gain not oncological control. Type, number, and timing of surgery were explored. 24% of patients received therapeutic surgeries (20% Surgical, 13% Chemoradiation, 32% Multi-Treatment, p=.07) including UES dilatations (n=12), VF augmentation, thyroplasty and PRP injections to VF (n=5), scar/flap revisions (n=11), Botox to TMJ (n=1) and multiple surgery types (n=6). Number of surgical procedures per patient ranged from 0-10. When controlling for T-stage, number of surgeries was associated with patient-reported EAT-10 and VHI-10 at 3mths (p<.01) but not treatment (Surgical M=.30, 0-3; Chemoradiation M=.47, 0-10; Multi-Treatment M=.72, 0-7, p=.82). Time to 1st therapeutic surgery ranged from 2-180mths (Surgical M=7, 2-20; Chemoradiation M=15, 2-180; Multi-Treatment M=11, 2-89, p=.10). 25% of cancer survivors require therapeutic surgeries. Need and timing for surgeries is difficult to predict. Frequent review and early consideration of intervention to maintain airway protection, optimise pharyngeal mobility and support swallowing can be helpful.