Abstract: Developed countries and our medium and large cities have become or are becoming aging societies, especially our large cities where the population over 60 years old is rapidly increasing. The incidence of head and neck cancer also increases with increasing age. The aging population has led to an increase in systemic systemic diseases and naturally to an increase in serious complications for the treatment of head and neck cancer. In the past two decades, the principle of treatment for head and neck cancer has been a combination of surgical resection-based treatment with extensive surgical excision and reconstruction, high-dose radiotherapy, and often combined with chemotherapy; in the last decade or so, biological therapies including immunotherapy, gene therapy, and especially molecular targeted therapy have progressed rapidly. Should elderly patients be treated with the same treatment plan as younger patients or should the treatment plan be changed based on their actual age?In 2007, at the EUFOS meeting of otolaryngology head and neck surgery in Vienna, the committee discussed this issue and came to a general conclusion.This paper gives a brief overview in the management of elderly patients in the context of the current status of oral and maxillofacial —- head and neck cancer diagnosis and treatment in China. Keywords: cancer, head and neck, elderly With the continuous improvement of living standards and the material and spiritual civilization of society, the average life expectancy of our population has significantly increased, and at the same time, we have started to enter an aging society rapidly. According to the standard of the World Health Organization, the age of 60 years or above is considered as old age, and according to the developed western countries, the age of 65 years or above is the stage of old age. The European National Institute for the Study of Aging uses three age stages to define elderly patients: younger people aged 65C74 (primary old age), older people aged 75C84, and older people aged 85 and above. The decline of multiple physiological functions in the elderly makes them susceptible to malignant tumors. according to 94 years of health statistics in China, tumors accounted for the first place among the elderly who died between 60 and 69 years old. among the elderly who died above 70 years old, tumors accounted for the second and third places depending on different information. The main reasons why elderly people are prone to malignant tumors are: long exposure to carcinogenic substances; decreased immune function of the elderly, weakened ability of the body to monitor cancer and low ability to kill cancer cells; weakened repair ability of deoxyribonucleic acid in cells; enhanced activity of oncogenes and weakened activity of anti-cancer genes. In Finland in 2006C2007, the percentage of cases of newly diagnosed cancer in the age group above 70 years was 31% for both men and women with laryngeal cancer, while for oral and pharyngeal cancers it was 30% for men and 48% for women. Oral and maxillofacial – head and neck tumors account for approximately 7-10% of all tumors in the body. The level of diagnosis and treatment has advanced with the development of medicine and biology. In terms of diagnosis and prognosis: research on tumor biomarkers is in full swing. Since the 21st century, exploring the specific genes of different tumors at the molecular level has become a major hot spot, and the main and commonly used method is gene microarray screening. Initially, several genes were found to be related to the development, metastasis and prognosis of head and neck squamous carcinoma. SCC Ag (squamous cell carcinoma antigen) is a glycoprotein fragment purified from tumor-associated antigen TA-4 by monoclonal technology, which was initially applied to the diagnosis of gynecological squamous carcinoma such as cervical and vaginal carcinoma, and later found to be abnormally increased in the blood of patients with squamous carcinoma of lung, esophagus and other organs, which is a good specificity of squamous carcinoma marker. CYFRA21-1, a subunit of CK19 keratin, has a molecular weight of 40 KD, and two antigenic determinants on its soluble fragment can specifically bind to two monoclonal antibodies BM19.21 and KS19.1. By detecting CYFRA21-1, it can reflect the changes in cytokeratin content. It has clinical significance for the detection of oral and maxillofacial – head and neck squamous cell carcinoma and is used to determine the prognosis. However, to date, no highly specific oral and maxillofacial —- head and neck cancer markers have been identified. Several studies have shown that older head and neck cancer patients over the age of 75 are less likely to receive stronger chemotherapy compared to younger patients based on age alone. Instead, complete surgical treatment and radiation therapy can be safely administered with no significant increase in overall complication rates. Radiation therapy plays a very important role in the treatment of head and neck cancers in the elderly, and improvements in radiation therapy techniques have led to improved outcomes and reduced side effects. In external irradiation, intensity modulation and 3D conformal radiotherapy have played a good role in maximizing the preservation of normal tissues and increasing the dose to the target area. cyberknife stereotactic radiotherapy uses an image-guided real-time tracking system to guide the robotic arm to track the target area for treatment. It is reproducible, highly accurate, less invasive, and widely applicable, and can be used for forward/reverse treatment planning, as well as fractionated treatment, and is compatible with both radiosurgery and radiotherapy. Proton radiotherapy: The energy decay shows a Bragg peak. The normal tissues in front of the tumor receive about 1/3 of the dose, and the posterior part of the tumor is basically unharmed, which is especially suitable for the treatment of head and neck cancer, especially nasopharyngeal cancer. Neutron radiotherapy: Neutrons are completely different from photons in tissue action, and can act directly on DNA, which solves the problem of radiation resistance in hypoxic tumors. It is more sensitive to salivary gland tumors and has significantly improved local control rate and slightly improved survival rate. Carbon ion radiotherapy: Most of the energy is distributed at the end of the trajectory, which improves the biological effect of the treatment within the ionization absorption peak, resulting in higher physical selectivity, improved dose distribution, concentrated dose within the target site, and reduced irradiation of normal tissues, thus, charged heavy ion radiotherapy is valuable in the clinical management of radiotherapy insensitive and periocular tumors. In cases that are not sensitive to radiotherapy and can still be operated, radiotherapy needs to be discontinued in time to leave an opportunity for surgery; otherwise, continuous high-dose radiotherapy will not control the development of the lesion, and radioactive osteonecrosis will occur, resulting in postoperative trauma non-healing and difficulties for local repair. Inter-tissue radiotherapy with nuclear 125 I particles has high local control rate, low adverse effects, better results especially for tumors of adenogenic origin, and preserves the facial nerve. The EUFOS committee summarized the feasibility and limitations of simultaneous radiotherapy (CRT) for the treatment of head and neck cancers in the elderly. and concluded that non-cancer-related mortality increases with age. Increasing age does not cause an increase in acute and late radiation toxicity, but reduced hepatic and renal compensatory function can affect chemotherapy delivery and reduce the efficacy of fractionated radiotherapy. Surgical treatment remains necessary for the management of head and neck cancer in elderly patients, and there is no evidence that advanced age is a contraindication to resection and reconstructive surgery in elderly patients. Adequate preoperative risk assessment is often the most effective measure to prevent perioperative complications in the treatment of head and neck cancers in the elderly. Age as an independent variable is clearly associated with overall status and overall medical condition rather than with surgical complications. Several authors have demonstrated the feasibility of free flap transfer reconstructive surgery in elderly patients, with success rates reaching up to 97%. Transnasal endoscopic surgery is also well suited for elderly patients with laryngeal cancer. In selected suitable cases, there are many benefits, such as short hospital stay, short procedure, oncologic safety and good functional protection. There is an increasing emphasis on comprehensive treatment and measures to prevent recurrence and metastasis in elderly patients with head and neck cancer. Radical resection and reconstructive surgery are given equal importance, and overall consideration is given to improving survival rate and quality of life, emphasizing that tumors are firstly excised; then functions such as mastication, swallowing and speech are restored; finally, consideration is given to restoring appearance as much as possible. In the surgical treatment of skin and mucous membrane defects of head and neck cancer, in order to cover the trauma and restore the shape and function as much as possible, reconstructive revision of tissues and organs is often required. The commonly used repair flaps are: Chinese flap, i.e. radial flap of forearm with vascular free graft; frontal flap, pectoralis major muscle flap, shoulder deltoid muscle flap, latissimus dorsi muscle flap, fibula composite flap and so on. These flaps, especially the composite flap with vascular free graft, require healthy blood vessels due to the use of microsurgical techniques for vascular anastomosis, and are not suitable for patients with atheromatous plaque in the carotid artery and its major branches, persistent hyperlipidemia, poorly controlled diabetes, and high blood viscosity. For patients with microsurgical vascular anastomosis free flap, the head and neck must be braked for 7-10 days, and the bedridden elderly are prone to joint stiffness of the limbs, slow venous return of the limbs and deep vein thrombosis, so it is necessary to strengthen the passive movement of the limbs. In this century, the advancement and clinical application of dental implant technology, especially the application of CAD/CAM and the clinical implementation of 3D rapid prototype technology and simulated restoration technology, has enabled the restoration of oral and maxillofacial defects to achieve the purpose of “individualized” treatment and rapidly improve the restoration results. In addition, dynamic repair of muscle flaps with nerves is also being used clinically with good results. The presence of systemic underlying diseases in the elderly is closely related to the occurrence of complications related to the treatment of head and neck cancer, and the actual 5-year survival rate of head and neck cancer patients can be reduced to 74-15% once diseases of the heart, lung, liver, kidney, brain and other important organs appear. Alcohol-dependent patients are also clearly associated with increased treatment complications. Careful preoperative planning and individualized treatment planning is essential. Cardiopulmonary monitoring during the operative period to avoid cardiac overload and prevent massive blood loss is also critical to the success of the procedure. Several studies have shown that older patients with head and neck cancer do not have a poorer quality of life after treatment than younger patients. In general, most older patients adapt and cope very well with the reality of having cancer, and their expectations seem to be lower. On the contrary, younger patients often obsess about the outcome of cancer treatment and are in a state of mental stress and anxiety. The single age factor itself is an unreliable decision parameter. Physiological status and psychological perception are more important factors, and a thorough preoperative evaluation and risk assessment is necessary. Comorbidities, functional status and reduced cognitive ability can all influence treatment outcomes more than age. Therefore, older patients should be treated with a more multidisciplinary and individualized approach.