Abstract: Objective:Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm, which mostly originates from the major and minor salivary glands of the head and neck region. This study aims to provide new information on head and neck ACC with cervical lymph node metastasis. Methods:Out of the616 patients who underwent primary tumor resection from 1995to 2008in the authors' hospital, 62cases with cervical lymph node metastasis were analyzed. Results:The general incidence rate of cervical lymph node me -tastasis in ACC was approximately 10% . The base of the tongue, mobile tongue, and mouth floor were the most frequent sites of lymph node metastasis with incidence rates of 19. 2%,17. 6%, and 15. 3%, respectively. Most cases exhibited the classic "tunnel-style" metastatic pattern of occurrence, and the levelⅠb and Ⅱregions were the most frequently involved areas. Primary site and lympho-vascular invasions were significantly associated with lymph node metastasis. High patient mortality rate was also significantly correlat -ed with a high number of lymph node positive cases. Conclusion: Cervical lymph node metastasis has a high tendency of occurrence in the tongue-mouth floor complex, following the classic "tunnel-style" metastatic pattern. Peritumoral lymphovascular invasion could be taken as a strong predictor for the occurrence of lymph node metastasis, which ultimately leads to poor prognosis of ACC patients. A selective neck dissection should be considered as a management in such patients.