Background <p>Head and neck squamous cell carcinoma (HNSCC) is a significant global health concern, constituting about 4.5% of all cancer diagnoses and fatalities. Tumor budding, characterized by single cells or small clusters at the invasive tumor front, has shown promise as a prognostic marker in various carcinomas, but its role in HNSCC requires further investigation.</p> Materials and methods <p>This retrospective study analyzed patients with HNSCC who underwent surgical resection from January 2023 to June 2024. Histopathological evaluation involved counting tumor buds in ten high-power fields and classifying them as low (0–4 buds), intermediate (5–9 buds), or high (≥ 10 buds). Clinicopathological parameters such as age, gender, tumor grade, stage, nodal involvement, depth of invasion (DOI), worst pattern of invasion (WPOI), lymphovascular invasion (LVI), and perineural invasion (PNI) were recorded. Statistical analyses assessed associations between tumor budding and these parameters.</p> Results <p>The study included 53 patients with a mean age of 47.2 years. Tumor budding was low in 9.4%, intermediate in 62.3%, and high in 28.3% of cases. Significant associations were found between higher tumor budding and higher stage (<i>p</i> = 0.01), worst pattern of invasion (<i>p</i> &lt; 0.01), lymphovascular invasion (<i>p</i> &lt; 0.01) and nodal involvement (<i>p</i> = 0.03). High budding was linked to greater DOI (<i>p</i> &lt; 0.01).</p> Conclusion <p>Tumor budding is significantly associated with aggressive clinicopathological features in HNSCC, including advanced stage and nodal involvement. Incorporating tumor budding assessment into routine histopathological evaluations could enhance prognostication and guide therapeutic decisions, potentially improving patient outcomes.</p>