Methods of treating malignant tumors of the extracranial portion of the head and neck have become more sophisticated. Cross-sectional imaging is extremely important in the evaluation of patients with a tumor in the head or neck. Although the complexities of head and neck radiology may be overwhelming, a uniform approach that first determines the location and extent of the primary tumor and then examines the nodal chains for metastatic adenopathy takes much of the mystery out of the process. MR imaging allows improved soft-tissue contrast and direct multiplanar acquisition of data, two advantages over CT. This review describes the current role of imaging in the clinical assessment of a patient with a malignant tumor in the head and neck, including the questions that must be answered before surgery and when MR imaging is the preferred technique.