Sentinel node biopsy is an evolving staging tool in the management of patients with squamous-cell carcinoma of the head and neck. This tool provides a more detailed understanding of the lymphatic pathways within the head and neck and the role of these pathways regarding tumor spreading. By targeting nodes that are most likely to harbor disease, a more detailed pathological evaluation of sentinel nodes is possible-thus improving staging by the identification of micrometastases. The rationale behind the use of sentinel node biopsy to stage the N0 neck are discussed within this paper.