In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squamous cell carcinoma (SCC), we separately dissected SRSR lymph nodes, and submitted them to) pathological examination. Fifty-three lateral neck dissections (LNDs), 2 radical neck dissections (RNDs), and 19 modified RNDs were performed in 49 previousy untreated patients with laryngeal SCC. The nodal status of the patients was NO in 29 patients, NI in 17, and N2 in 3. The neck vase pathologically positive in both RNDs (100%), in 7 of 19 modified RNDs (37%), and in 7 of 53 LNDs (13%). No SRSR lymph nodes were positive in any of the dissection materials. No metastasis was found in the SRSR lymph nodes in the NO necks treated with LND, and none was found even in N1 and N2 necks treated with RND or modified RND. We conclude that the SRSR may be left undissected during treatment of an NO neck with LND so that accessory nerve dysfunction can be minimized and operative time can be saved.