In regard to management of the neck in cases of early oral cancer, elective neck dissection(END) is recommended rather than a watch &amp
wait policy, because of occult cervical metastasis in more than 20% of cases as well as poor survival rates. Regarding END surgery, in which complications and postoperative disorders often occur, preservation of the carotid sheath and prevertebral layer of cervical fascia prevents damage of facing cervical nerves and vessels. To avoid unnecessary neck dissection and prevent occult cervical metastasis we have performed sentinel node navigation surgery (SNNS) for early oral cancer patients at Fukushima Medical University Hospital since 2000.99mTc-labeled phytate was injected as a radiotracer to search for sentinel lymph nodes(SNs). The SNs were then examined histopathologically during surgery. When metastasis in SNs is detected, END is performed, but when metastasis in SNs is negative, neck dissection is not performed and the patient is closely followed. As a result, the survival rate in the SNNS group tends to be better than that in the historical control group. In Japan, a multi-institutional phase III study of SNNS for head and neck cancer has been started, and in the near future SNNS is expected to be a common decision in management of the neck in cases of early oral cancer.