Head and Neck Squamous Cell Carcinoma (HNSCC) is a highly aggressive malignant tumor. Traditional therapeutic approaches have limited efficacy in locally advanced HNSCC patients, and neoadjuvant immunotherapy has emerged as a new hope. However, the current outcomes of neoadjuvant immunotherapy for HNSCC are not yet optimal and urgently need improvement. This article comprehensively reviews the clinical research progress of neoadjuvant immunotherapy in the field of HNSCC treatment. By integrating perspectives from the regulatory mechanisms of the immune microenvironment, we propose future research directions for enhancing the efficacy of neoadjuvant immunotherapy for HNSCC patients.