<p>Exosomal long non-coding RNAs (lncRNAs) have emerged as critical regulators in the pathogenesis, progression, and metastasis of head, neck, and thyroid cancers. These molecules, encapsulated within exosomes and released into biological fluids, mediate intercellular communication and influence various oncogenic processes including epithelial-mesenchymal transition (EMT), angiogenesis, immune evasion, and therapy resistance. Recent studies have demonstrated that specific exosomal lncRNAs are differentially expressed in cancer patients compared to healthy individuals, making them promising candidates for non-invasive biomarkers in early diagnosis, prognosis assessment, and treatment monitoring. In addition, several exosomal lncRNAs actively participate in modulating the tumor microenvironment, supporting cancer cell proliferation, migration, and metastatic potential. Therapeutically, targeting oncogenic lncRNAs or restoring tumor-suppressive ones offers new strategies for overcoming drug resistance and enhancing treatment efficacy. However, there are some areas of ambiguity and conflicting data in this topic. Thus, despite their promise, further large-scale and longitudinal studies are needed to validate their clinical utility of exosomal lncRNAs. This review summarizes the current knowledge on the biological functions and clinical applications of exosomal lncRNAs in head, neck, and thyroid cancers, highlighting their potential as biomarkers and therapeutic targets in modern oncology.</p>