Background: Squamous cell carcinomas (SCC) of the oral cavity show a great tendency to invade cervical lymph nodes, and such metastasis is an important prognostic factor. However, the treatment of cN0 (clinical N0) neck is still a controversial issue. The aim of this study was to compare the results of ipsilateral neck dissection versus bilateral treatment in patient with cN0, stages I and II and to find out in how many patients metastases appeared.

Methods: We performed a retrospective analysis of 96 patients with stage I or stage II SCC of the oral cavity and cN0 neck undergoing neck dissection levels I–III ipsilateral or bilateral. The management of the cN0 necks involved 35 ipsilateral and 61 bilateral neck dissections. Management of the neck was based on the site and stage of the primary cancer. The follow-up period ranged from 8 to 69 months, with a mean of 32 months.

Results: 11 patients of the bilateral neck dissection group showed metastases (18%, 11 of 61). Of these, 4 patients (7%, 4 of 61) had ipsilateral metastases in the neck. The other 7 patients of the group who did receive bilateral neck dissection showed distant metastases in liver and lung. In the ipsilateral neck dissection group 3 patients developed metastases (9%, 3 of 35). In all cases metastases developed on the ipsilateral side. Disease recurred in 7 of 61 patients in the bilateral group and in 4 of 35 patients in the ipsilateral group.

Conclusion: Our data indicates that contralateral metastases in stages I and II SCC were rare. Furthermore our study confirms the non inferiority of ipsilateral versus bilateral management of patients with cN0 neck and strict ipsilateral localization of the SCC.