Background: Oropharyngeal squamous cell carcinoma (OPSCC) is a common malignancy in the head and neck region, with cervical lymph node metastasis being a critical factor influencing prognosis and treatment planning. The aim of this study was to characterize the patterns of cervical lymph node metastasis in OPSCC patients and to evaluate its impact on management strategies. Methods & Materials: A cross-sectional study was conducted at the Department of Otolaryngology & Head-Neck Surgery, Sylhet M.A.G Osmani Medical College Hospital, from September 2018 to August 2020. A total of 100 patients with OPSCC and metastatic cervical lymphadenopathy were selected based on predefined inclusion and exclusion criteria. Data were collected using a structured questionnaire and clinical examination, including fibre-optic laryngoscopy (FOL), imaging (CT/MRI), punch biopsy of oropharyngeal lesions, and fine-needle aspiration cytology (FNAC) of enlarged lymph nodes. Histopathological analysis was performed by the same pathologist. Statistical analysis was carried out using SPSS version 26. Results: The study found that the palatine tonsil was the most common primary site of lymph node metastasis, with 75% of patients presenting with ipsilateral lymph node involvement. The most common carcinoma stage was T2, while the predominant lymph node stage was N3. Level II and Level III lymph nodes were most commonly involved. The findings suggested that the patterns of lymph node metastasis are crucial for treatment decisions, including the choice between primary surgery, chemoradiation, or surgery after chemoradiation. Conclusion: This study emphasizes the importance of cervical lymph node involvement in managing OPSCC. The findings offer valuable insights for treatment planning, especially regarding neck dissection and chemoradiation. Larger studies with extended follow-up are needed to confirm these patterns and refine treatment strategies for OPSCC patients with lymph node metastasis