BACKGROUND Occult nodal metastasis (ONM) occurs in up to 30% of patients with oral cavity squamous cell carcinoma (OCSCC). This study aimed to identify the prevalence and predictive factors for occult nodal disease in patients with a diagnosis of OCSCC with a clinically negative (N0) neck over a 22 year period at the Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital. METHODS All patients with a pathological diagnosis of OCSCC with a clinically N0 neck, undergoing elective neck dissection (END), between 2009 to 2021 at Hutt Hospital were identified from our Head and Neck Database. Patients with ONM were identified and univariate analysis was performed to identify patient and tumour features which may be risk factors for ONM. RESULTS Of 187 patients identified, 44 (23.5%) had ONM. Poorly-differentiated tumours (OR 7.7, 95% CI 1.97-30.1, p=0.03), presence of lymphovascular invasion (LVI)(OR 3.84, 95% CI 1.59-9.23, p=0.003) and depth of invasion (DOI)(4% increase in odds of ONM per millimetre increase in DOI, p=0.043) were significantly associated with increased odds of ONM. There was no significant association between T-stage, perineural invasion, tumour-subsite and ONM. Patient demographics including gender, smoking status, alcohol use, deprivation score and comorbidities were not statistically significant risk factors for ONM. CONCLUSION The prevalence of ONM amongst our cohort of patients with OCSCC undergoing END, was 23.5%. Poorly differentiated tumours, LVI and DOI were associated with an increased risk of ONM. No patient demographic features were independent risk factors for ONM. Larger cohort studies are warranted to further explore prognostic factors for ONM in OCSCC.