OBJECTIVE To investigate the incidence, localization, correlation to primary tumour and therapeutic results in supraglottic carcinoma patients with occult metastatic neck nodes. METHODS The study included patients with supraglottic laryngeal carcinoma treated in the period 1976-1993. They all had clinically negative findings in the neck (N0) and had undergone primary surgery with curative intent. Bilateral selective neck dissection at the level II-IV was performed in all patients. RESULTS One hundred ninety-three patients were studied. Occult cervical node metastases were found in 18% (35/193) of them. The incidence of occult metastases in cases with epilaryngeal primary tumour was 19% (14/72), while it was 17% (21/121) in supraglottic carcinoma excluding epilarynx. Ipsilateral occult metastases were more common (27/35, 77%), but both bilateral and contralateral spread was also seen (5/35, 14% and 3/35, 9%, respectively). Postoperative radiotherapy was delivered to all patients with confirmed occult metastases. Only in 2 (1%) did metastases develop subsequently, indicating the effectiveness of the planned postoperative radiotherapy. CONCLUSIONS Considering the tendency of supraglottic carcinoma for frequent occult cervical metastases we believe that selective level II-IV cervical node dissection should be carried out, followed by locoregional radiotherapy in case of histologically confirmed nodal micrometastases.