Introduction: Adenoid cystic carcinoma (ACC) is a rare malignancy arising from secretory glands, most commonly involving the salivary glands It accounts for approximately 1% of all malignancies of the head and neck region. However, it is the most common tumor of the minor salivary glands and the second most common tumor of the major salivary glands. Overall, it accounts for 10% of all salivary gland tumors. Objectives: The main objective is to find the prognostic factors and survival in adenoid cystic carcinoma of the head and neck. Methodology: This retrospective study was conducted at JPMC Abbasi Shaheed Hospital Karachi and LUMHS Jamshoro during 2020 to 2024. Data were collected from 45 patients diagnosed with adenoid cystic carcinoma (ACC) of the head and neck and treated between 2020 to 2024. Patients with confirmed histological diagnosis of ACC in the head and neck region, and their medical records were complete, allowing for detailed analysis of their treatment and outcomes were included in the study. Results: Data were collected from 45 patients. Mean age of the patients were 52.31±3.49 years and there were 19 (42.2%) male and 26 (57.8%) female patients. Tumor is located at major salivary glands in 30 (66.7%) and minor salivary gland in 15 (33.3%) patients. Out of 45, 24 (55.6%) patients are from TNM stage I and II, 20 (44.4%) are from TNM stage III and IV. 35 (77.8%) patients came across radiotherapy measures and 10 (22.2%) did not came across any type of therapy. Patients with advanced tumor stages (III-IV) are 2.5 times more likely to experience mortality than those with early-stage tumors (I-II) (p=0.01). Solid histological subtypes carry a 3.0 times higher risk compared to cribriform or tubular types (p=0.03). Positive surgical margins also significantly increase the risk of adverse outcomes by 2.8 times (p=0.02). Conclusion: It is concluded that tumor stage, histological subtype, surgical margin status, perineural invasion, and distant metastasis are key prognostic factors influencing survival and recurrence in adenoid cystic carcinoma of the head and neck. Early-stage disease, negative surgical margins, and cribriform or tubular subtypes are associated with better outcomes, while advanced-stage tumors, solid histology, and distant metastasis predict poorer prognosis.