Surgery and radiotherapy both provide effective local management of squamous cell cancer of the head and neck. Nonetheless, these approaches impact patient quality of life in distinct ways, and it is important for the otolaryngologist to recognize the capabilities and limitations of nonsurgical therapy. Advances in radiotherapy delivery, surgical techniques, chemotherapy agents, and biological approaches promise significant improvements in survival and functional outcomes for patients with advanced disease treated with organ-preservation therapy over the next decade.

Head and neck cancer is the seventh most common cancer in the world. The incidence varies by geographic region and is influenced by the differential exposure to the major risk factors of HNC. Risk factors include tobacco and alcohol use, human papillomavirus, male gender, and old age. Human papilloma virus has been identified as an important causal factor in oropharyngeal cancer, the incidence of which has been steadily increasing. Epidemiologic studies provide important information allowing for development of preventative measures and treatment.

The loss of voice is generally considered the most disabling consequence of total laryngectomy. Post-laryngectomy voice rehabilitation is a critical component of caring for patients who undergo total laryngectomy. The evaluation and education of patients should occur simultaneously with the cancer treatment plan. Optimal therapy includes a multidisciplinary approach with both the surgeon and the speech pathologist working together.

Rapid advances are being made in the treatment of advanced head and neck squamous cell cancers (SCCHN). Chemoradiation with cisplatin as the most established regimen is the standard of care for post-surgical patients with positive margins or extracapsular extension of tumor in lymph node. For definitive, non-surgical treatment, the addition of chemotherapy or the EGFR-monoclonal antibody cetuximab to radiotherapy has been shown to improve survival compared to radiation alone with high-dose cisplatin being the most established regimen.

Most tracheal neoplasms in adults are malignant, with the vast majority of those tumors showing squamous cell or adenoid cystic pathology. Most adults present with subtle clinical symptoms including worsening dyspnea and wheezing. CT chest is helpful in characterizing a tracheal neoplasm, but the mainstay of diagnosis is bronchoscopy. Tracheal neoplasms are best managed with surgery, either bronchoscopic resection (for certain benign tumors only) or tracheal resection and anastomosis.

Infections of the deep neck occur in a very anatomically complex area. Multiple potential spaces and routes of entry can readily allow the spread of infections from the oral cavity, oropharynx, and salivary glands into the deep neck compartments. Infections can occur both in the pediatric and adult population, for which differences in etiologies and management decisions must be carefully considered.

Orbital tumors are a rare and diverse group of diseases. They can present with a variety of symptoms and signs, but early recognition is important. Primary orbital tumors can be benign or malignant in nature, although secondary lesions invading from local anatomical structures are more common. A variety of treatment modalities are available depending on the underlying pathology, but locally advanced disease may require an aggressive multimodality treatment plan requiring sacrifice of the orbital contents with complex reconstruction.

Paranasal sinus malignancies comprise a diverse group of histologies, accounting for approximately 3% of upper aerodigestive tract malignancies. Most malignancies are diagnosed within the 5th and 6th decades of life, are more prominent in Caucasians, and disproportionally affect men twice as often as women. Malignancies of the paranasal sinuses frequently present at more advanced stages, as compared to cancers of the nasal cavity.