Swallowing dysfunction following radiation therapy for head and neck cancer is a major cause of morbidity and reduced quality of life, which means that organ preservation is not equal to functional preservation. Radiation induces tissue damage followed by hypoxia, fibrosis, and functional deterioration. Intensity modulated radiation therapy can be a valid strategy to reduce long-term dysphagia. Recently, prophylactic swallowing exercise has been gaining attention for its role in better functional swallowing after radiation therapy. However, further longitudinal and objective studies are still needed.