Cancer is the second major cause of death after heart disease worldwide. The most common oral cancer is squamous cell carcinoma. Oral cancer in Bangladesh showed tobacco as main etiological factor. In western world oral cancer incidence is 3-5%, on the other hand, due to beetle-nut chewing habit in Bangladesh the incidence rises up to about 40%. Initially it is a local disease of the oral cavity, with passing of the time it progress as regional diseases due to lymph nodal metastasis. Then in advanced stage it becomes a systemic disease due to distance metastasis.
Rationale of treating Squamous cell carcinoma which has metastasized to regional lymph nodes is based on the fact that treatment of primary disease and lymphatic metastasis of the neck. Neck metastasis by a oral squamous cell carcinoma is firm statement of its aggressive malignant nature and its advanced condition.
Once dissemination to regional lymph nodes take place, the probability of 5 years survival, regardless of the treatment rendered, reduce to nearly one half of that seen in early staged patients. Therefore first detection of metastasis then the control of neck metastasis is one of most important aspects in successful management of oro-facial squamous cell carcinoma. Knowledge of the basic principles of oncology and expertise in patient assessment and in individual speciality are essential for staging work up of the patients and treatment selection and integrated interdisciplinary collaboration.
Once the neck has suspicious metastatic disease, then for adequate treatment, evaluation of neck is important. Preoperatively there are many options for neck evaluation. As follows:
 Physical examination (PE)
 Contrast-Enhanced Computed Tomography (CECT)
 Magnetic Resonance imaging (MRI).
 Ultrasonogram
 2-Fluoro-2-deoxy-glocose (FDG) Positron Emission Tomography (FDG-PET) etc.
Among them contrast enhanced computed Tomography (CECT) is the most common modality employed to assess the cervical lymphatic metastasis after palpation.
There are no ideal method for identification of metastatic neck disease. Therefore false positive and false negative is not uncommon. Adequate management cannot be standardized if all precaution is not taken for more accurate detection of metastatic neck nodes.