Background: Intraoperative consultation with frozen section is an important tool for evaluation of adequate surgical margins. Nevertheless, it is believed that frozen section analysis is less accurate in irradiated nasopharyngeal carcinoma (NPC) compared to other head and neck cancers. The current study was to investigate the accuracy of intraoperative consultation of irradiated NPC. Methods: A total of 38 patients with irradiated NPC who had undergone endoscopic laser-assisted nasopharyngectomy for the period 2010 to 2022 were retrospectively analyzed. Results of intraoperative consultation of resection margins were reviewed. In addition, we performed a comparison of frozen section diagnoses between the current irradiated NPC cohort and an irradiated oral cavity cancer cohort. Results: A total of 205 comparative sets of frozen section and permanent pathology results of nasopharyngectomy were used for analyses. The accuracy of intraoperative consultation was 100%. Nevertheless, 69 out of 205 intraoperative consultations resulted in a deferral of immediate diagnosis. The deferral rate was significantly higher than that of the comparative oral cavity cancer cohort (P<0.001). Conclusion: The current study demonstrated intraoperative consultation of irradiated NPC was challenging. In a significant number of specimens immediate diagnosis was difficult