Computed tomographic (CT) scanning has been used in the preoperative examination of patients with head and neck cancer. Although early reports on the use of CT scanning for cervical lymphadenopathy were encouraging, the accuracy of CT in detecting nodal metastases has not been well established. Fifty consecutive patients underwent radical neck dissection and preoperative CT scanning. The clinical staging of the neck, CT diagnoses, and pathologic findings were correlated; CT accuracy was then compared with clinical accuracy. Our findings show the overall accuracy of CT diagnoses to be 90%. Comparison with clinical accuracy shows the CT scan to be superior to the clinical examination, particularly in detecting occult metastases.