Abstract: Objective:To investigate the effect of perineural invasion (PNI) on patients with early squamous cell carcinoma of the tongue (ESCCT) and the controversial issues related to PNI's effect on loco-regional recurrence, cervical lymph node metastases, and prognosis. Methods:Data of 156 patients with ESCCT were analyzed. Two subgroups comprising 40 patients each were investigated. One was PNI-positive subgroup, and the other subgroup was consisted of patients with PNI-negative carcinomas. These patients had similar histopathological characteristics and were randomly selected from the total number of cases. The relationship among the prevalence of PNI, loco-regional recurrence, cervical lymph node metastases, and prognosis was analyzed. Results:PNI was significantly correlated with high cervical lymph node metastases and poor5-year survival rates (P=0.045 and P=0.034, respectively) but not with local recurrence ( P=0.531). Elective neck dissection was considerably associated with a low risk of regional recurrence among the PNI-positive ESCCT patients ( P=0.001). Conclusion: PNI should be considered as a predictor for high cervical lymph node metastases and poor5-year survival of early tongue squamous cell carcinoma. Elective neck lymph node dissection should be performed among patients with PNI-positive early tongue squamous cell carcinoma.