This study prospectively follows changes in quality of life (QoL) of 40 patients undergoing surgical treatment for head and neck malignancy over a 1-year period, using the University of Washington QoL questionnaire version 4.0. The tumour types included oral, oropharyngeal, hypopharyngeal, oesophageal, laryngeal, sinonasal and thyroid carcinomas. Mean overall QoL scores were significantly worse at 3 and 6 months (P < 0.05) and returned to around preoperative scores at 12 months (P = 0.11). Oropharyngeal, laryngeal, sinonasal and thyroid subsites all maintained QoL scores at each time point. QoL scores for hypopharyngeal and oral subsites dropped markedly at 3 and 6 months but returned to around preoperative levels at 12 months. The domains most affected by treatment varied depending on tumour subsite. For the population as a whole, their appearance, activity, speech, shoulder and saliva domains were all significantly less at 12 months. Anxiety scores were significantly better at 12 months.