This chapter discusses the prevalence and distribution of cervical metastasis in oral cavity squamous cell carcinoma (OSCC). In the retrospective analysis, patients were subclassified by the clinical node status N0 or N+ and three neck dissection (ND) treatment groups: elective dissection (ED) for patients with a clinically N0 neck, a therapeutic or immediate therapeutic dissection (ITD) for patients with cervical metastasis (N+), or subsequent therapeutic dissection (STD) for salvage (N+) cases with initially conservative management of the neck and subsequent relapse with cervical metastasis (N+). By the 1960s, increasing numbers of surgeons including Bocca from Italy and Ballantyne from MD Anderson felt that this radical approach of removing non-lymphatic structures was too morbid for early disease (N1), leading to the modified radical and functional approaches in ND.