Objective: This retrospective study is to find reliably risk factor of lymph node metastasis and to discuss a reasonable neck management for T1-2N0 oral tongue squamous cell carcinoma. Methods: 136 cases were performed neck dissection ( ND), 62 cases were under watch-and-wait (WW). The clinical, pathological, imaging and follow up data of two groups were analyzed. Results: There was no significance difference between group ND and group WW for recurrence and overall survive and the same result for the statue of neck lymph node between T1 and T2 patients. Among all patients the histopathological differentiation, vascular invasion and invasion thickness were significant for recurrence, overall survive and the statue of neck lymph node. The tumor thickness measured on MRI images had significant correlation with invasion thickness. Conclusion: For the patients with T1 OTSCC the WW protocol is recommended, for T2 cases, the WW protocol is also reasonable. The neck dissection should be considered in cases with poor differentiation, invasion thickness more than 4 mm measured on MRI images. For the patients with pathologically proved invasion thickness more than or equal to 4 mm or vascular invasion, neck dissection or more aggressive adjuvant treatment should be performed.