A retrospective study of 53 patients was undertaken to evaluate the efficacy of computer tomography (CT) in the detection of nodal metastases from carcinomas of the head and neck. The CT findings of 53 patients with head and neck carcinomas who underwent a total of 57 neck dissections were compared with the findings of physical examination (PE) and histopathological examination. Using node size larger than 10 mm in the short-axis diameter or the presence of central lucency as the criteria of nodal metastasis CT scanning staged correctly 52 of 57 necks, providing an accuracy of 91%, a sensitivity of 86% and a specificity of 100% in the detection of nodal metastases. There was agreement of PE findings with histology in 43 (74%) of 57 necks, with a sensitivity of 97% and a specificity of 38%, respectively. Because CT scanning was superior to PE in the pre-operative staging of head and neck carcinomas, it should be used for pre-operative evaluation of metastatic neck disease.