As the average age of individuals across the world continues to rise, the elderly represent an increasing proportion of patients with head and neck cancer. 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 elderly 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 elderly 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 elderly 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. The tumor board discussion will provide a rich foundation of six patient cases, with discussion and debate by widely renowned panelists. Audience participation and feedback via live, interactive polling throughout the cases will be integrated to help shed further insight into practice patterns, audience preferences, and changes in opinion as the seminar progresses. Given the challenges posed by this unique set of patients, this topic should be of value to otolaryngologists across diverse practice settings.