For its rich lymphatic drainage, metastatic neck localization is common even in early-stage OSCC and is one of the most important adverse factors. A positive neck, in fact, drastically reduces the survival rate by 50%. For this reason, the management of the neck is an important issue when treating OSCC. While in a positive neck for lymph node metastases neck dissection is mandatory, in a negative neck in preoperative assessment, the management is very debatable. This chapter aims to clarify the different approaches in neck management based on tumor stage. For each option, pros and cons will be discussed. Finally, our approach of choice will be openly supported by a long experience and some future studies that could potentially change it.