As the average age of individuals across the world continues to rise, an increasing proportion of patients with head and neck cancer are in the geriatric age range. Comorbid conditions, restricted life expectancy, and other factors must be carefully considered when exploring treatment options for these patients, including traditional modalities of therapy (surgery, radiation, and systemic therapy) and palliative options. However, these patients also pose unique challenges when undergoing treatment, as older patients are more likely to experience complications and treatment interruptions. In this seminar, we will provide an interactive but didactic introduction to the management of older patients with head and neck cancer followed by a tumor board-based panel. The didactic portion will provide an evidence-based summary of the options (including reconstructive techniques), challenges, outcomes, and complications associated with treating older head and neck cancer patients. Patient indices other than age, which can be helpful in the medical decision-making process, will also be discussed, along with palliative care and the surgeon's role in facilitating palliation. Given the challenges posed by this unique set of patients, this topic should be of value to otolaryngologists across diverse practice settings.