Abstract: Objective: To investigate the Level Ⅳmetastasis risk factor of oral cancer patient's ipsilateral neck.Methods:The medical records of 624 cases ( 644 sides of the neck) that underwent neck dissection at the time of primary surgery for oral carcinoma were included. Chi-square test and logistic regression analysis were performed to determine the factors associated with Level Ⅳmetas-tasis. Results: Out of 334 cases ( 345 neck sides) with positive lymph nodes, only 35sides ( 5.43%,35/644) showed Level Ⅲinvolve-ment and only 4 sides ( 0.62%,4/644) developed skip metastasis (Level Ⅲ). The metastatic rate of Level Ⅳwas 1.31%(4/303) for pN -Levels Ⅰ- Ⅲnecks and9.14% (31/341) for pN+Levels Ⅰ- Ⅲnecks. Using Chi-square test, pN+Levels Ⅰ- Ⅲlymph node metastaseswere associated with the Level Ⅳnodal metastases. For necks with pN+ LevelⅢ, with three positive Levels among Levels Ⅰ- Ⅲ, and with positive lymph node≥ 3 among Levels Ⅰ- Ⅲ, the Level Ⅳmetastasis rates were22.47% (20/89), 28.57% (10/35), and 14.60% (20/ 137), respectively. Furthermore, logistic regression was applied to identify the relationship between the metastasis situation of the afore -mentioned three Levels and Level Ⅳ. Three positive Levels among Levels Ⅰ- Ⅲ(pN+LevelⅠ+ pN+ LevelⅡ+ pN+LevelⅢ) were confirmed to correlate with the presence of the positive lymph nodes in Level Ⅳ. Conclusion:In oral cancer patients, Levels Ⅰ- Ⅲ metastaces will increase the risk of LevelⅣmetastasis.