Abstract: Tongue squamous cell carcinoma is the most frequent malignant tumor in the oral cavity. The incidence of occult metastasis in early-stage tongue squamous cell carcinoma ranges from 19.81% to 61.8%. The sensitivity, specificity, and accuracy of currently employed diagnostic techniques vary among different research centers. Cervical lymph nodes in tongue squamous cell carcinoma exhibit certain regularities, with metastasis primarily occurring in ipsilateral levels I, Ⅱ, and Ⅲ, and occasional occurrence of skip metastasis. Occult metastasis to cervical lymph nodes in tongue squamous cell carcinoma is influenced by various factors. The treatment approach for the neck remains controversial, with options including selective neck dissection, observation, and sentinel lymph node biopsy. This review aims to elaborate on the incidence of occult lymph node metastasis in patients with tongue squamous cell carcinoma, the distribution patterns of metastatic lymph nodes, the value of various diagnostic techniques in detecting occult metastasis, risk factors for occult metastasis, and strategies for neck management.