Treatment for head and neck squamous cell carcinoma (HNSCC) includes surgery, radiotherapy and chemotherapy. The high recurrence rate and metastasis of HSNCC after treatment are the main factors affecting the prognosis of HNSCC patients. HSNCC radiotherapy and chemotherapy have various complications including radiation-induced mucositis and local soft tissue injury, which seriously affect the quality of life of patients. The hypoxia tumor microenvironment is closely related to tumor radioresistance and clinical recurrence. If measures can be taken to ameliorate hypoxia in the tumor microenvironment, it is possible to improve the therapeutic effect of HNSCC. In this review, we will explore the current treatment of HNSCC, the mechanism of radiotherapy resistance related to HNSCC hypoxic microenvironment,and the methods of detecting tumor hypoxic and enhancing radiotherapy sensitization.