**Abstract**

Early stage oral cavity squamous cell carcinoma (OCSCC) has a significant risk of subclinical nodal metastases, which is the strongest independent prognostic factor for regional recurrence and survival. However current preoperative imaging modalities are unable to identify patients with micrometastases, and an observation strategy has been associated with inferior outcomes when compared to an elective neck dissection. Sentinel lymph node biopsy provides a safe and accurate staging procedure to select the patients who benefit from an elective neck dissection, while avoiding unnecessary surgery in the patients who are node negative. There is recent Level II evidence demonstrating equivalent oncological outcomes when compared with elective neck dissection. However, a multidisciplinary approach is required including reliable mapping of the sentinel lymph node, precise surgical technique and comprehensive histopathological analysis to ensure accurate results are obtained.

**Keywords:** Oral squamous cell carcinoma, oral cancer, head and neck cancer, sentinel lymph node, elective neck dissection, nodal metastases, lymphoscintigraphy
