The significant prognostic impact of regional metastasis in head and neck cancer means accurate pre-treatment staging for the neck is critically important to correctly stratify management. Due to the risk of occult metastasis, treatment of the cN0 neck in patients with early oral cancer has been a matter of intensive research and debate. Surgical excision of the “at risk” lymph nodes by standard elective lymph node dissection (ELND) has superior disease control to observation, however in general there is a move towards minimally invasive and patient specific management. Sentinel lymph node biopsy (SLNB) is a surgical staging procedure for the cN0 neck, which can identify occult metastasis with high sensitivity and specificity but introduces an additional step into the treatment pathway. In this chapter we will evaluate the evidence for management of the cN0 neck in oral cancer, specifically relating to the advantages and disadvantages of ELND and SLNB and including recent guidelines and ongoing clinical trials.