Objective:To investigate factors that benefit patients with head and neck osteosarcoma (HNOS) before death.Methods:Patients admitted in our department from 2007 to 2015 who died during follow-up after surgery for HNOS were selected.Information concerning demographics,disease,treatment and follow-up were collected and analyzed.Results:A total of 77 patients died at a median age of 42 years old,of whom 33 were male and 44 female.Thirty-nine tumors were identified in the maxilla and skull base region while 38 in the mandible.Positive surgical margins were observed in 7 cases.Twenty patients received adjuvant chemotherapy,and 36 received postoperative radiotherapy.Local recurrence,as an initial cause of death,occurred in 25 cases,whilst metastasis occurred in the rest.Conclusion:Patients with HNOS benefit from negative surgical margins and adjuvant chemotherapy before death.Patients above 30 years old have longer disease-free survival,and patients with tumors of low pathological grade have longer overall survival.Tumor size and postoperative radiotherapy are negative prognostic factors.Frequent follow-up should be conducted for at least 48 postoperative months.