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Comprise approximately 6% of the HNSCC . Most are SCC histologically; other histology commonly encountered here are salivary gland tumors , esthesioneuroblastomeas, sinonasal undifferentiated carcinomas ,neuroendocrine carcinoma and rarely sarcomas. The treatment of these lesions ( except for pooply undifferentiated cancers ) is usually radical surgery encompassing the complex anatomy of this region not necccessarily in an enbloc fashion but more importantly in an oncologically adequate manner with negative margins. Complete resection is usually associated with long term control. The need for resecting the orbit and anterior and middle skull base are some of advances in H&N surgical oncology that have revolutionized local control and improved survival . Since perineural spread confounds complete resection, advances in H&N radiation oncology such as Intensity modulated radiation therapy (IMRT ) is utilized to optimize control in key areas with vastly improved local control rates . Other advances in reconstructive surgery such as microvascular free tissue transfer has permitted reconstruction of facial, orbital skull and palatal contour in an aesthetically and functionally acceptable manner . Advances in facio –maxillary prosthetics have vastly improved masticatory defects as well speech handicaps so that post surgery the outlook for these “controlled” patients is far from dismal .