Management of clinically node negative neck patients with oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) is used on an assumption of difficulty in diagnosing subclinical nodal metastases in the neck. This is also the case when early dissection allows better prognosis if nodal metastases actually exist. However, the disadvantage of prophylactic END is that truly N0 neck patients undergo unnecessary neck dissection and have to bear shoulder complaints and dysfunction. Our strategy has been a" wait and see" policy for the management of the neck among patients with T1-2 oral cancer without clinical nodal metastases unless the neck was being opened for reconstruction requirements. The purpose of this study is to assess the outcome of patients who underwent trans-oral tumor excision and" wait-and-see" policy for the N0 neck. A total of 94 previously untreated patients with T1-2N0 classification were investigated. Elective neck dissection (END) was carried out on 10 patients (10.6%) at the time of treatment of the primary resection with reconstruction (END group), and 84 patients were observed without neck dissection (Observation group). The 5-year disease specific survival rates were 90.0% for the END group and 95.9% for the observation group. The 5-year over all survival rates were 90.0% in the END group and 88.8% in the observation group. In the observation group of 84 patients, 16 patients (19.0%) had delayed metastasis in the neck subsequently. 15 patients underwent salvage neck dissection. The salvage rate was 86.6% (13/15 patients). The treatment strategy "wait and see" policy for T1-2N0 OSCC resulted in a good outcome at our institution. Unnecessary neck dissection can be avoided for the truly N0 patients.