This thesis provides a comprehensive review of the management of the clinically negative neck (cN0) in early-stage oral cavity squamous cell carcinoma (OSCC). It effectively emphasizes the paradigm shift toward utilizing Depth of Invasion (DOI) as a critical histopathological predictor, establishing that a DOI exceeding 3–5 mm necessitates elective surgical intervention. The work critically evaluates primary treatment protocols, including Elective Neck Dissection (END) and the less invasive Sentinel Lymph Node Biopsy (SLB), highlighting their roles in achieving regional control while preserving quality of life. Furthermore, it identifies aggressive markers like the Worst Pattern of Invasion (WPOI) and tumor budding as vital factors for risk-stratified decision-making. Ultimately, the research concludes that a personalized, evidence-based approach is essential for optimizing patient survival and reducing the burden of overtreatment.