Background: The aim of this article was to assess the management of the neck and regional recurrence for squamous cell carcinoma of the maxillary alveolus and hard palate (n = 43) and compare that to the rest of the oral cancer sites (n = 465). Methods: This is a retrospective report through database and case note review. Results: The incidence of nodal metastases (pathologic node–positive necks added to regional recurrence for clinical N0 and pathologic N0) was 37% (16/43) for maxillary alveolus and hard palate compared with 40% (187/465) for the oral cavity in general. Regional recurrence occurred in 26% (11/43) in the maxillary alveolus and hard palate compared with 7% (31/465) in the remaining oral cavity sites (p = .001). Conclusions: Squamous cell carcinoma arising in the maxillary alveolus and hard palate has a similar risk of regional metastasis as the rest of the oral cavity, and a lower propensity for selective neck dissection is resulting in higher regional recurrence and lower survival rates.