Oral carcinoma seldom metastasizes to the lateral retropharyngeal lymph node, so-called Rouviere lymph node (RN) . In this report, two cases of RN metastasis on bilateral sides from cancer of the oral and maxillofacial region are presented. A 51-year-old male patient developed local recurrence and bilateral neck nodes involvement after receiving partial maxillectomy to resect upper gingival cancer (T1N0) . Although bilateral neck dissection and subtotal maxillectomy were performed, CT revealed a RN metastasis on one side 8 months later. In spite of repeated chemotherapy, another RN metastasis on the opposite side was found by CT after about 6 months. Therefore, the disease was diagnosed as bilateral RN metastases. The other patient was 66-year-old male with maxillary sinus cancer (T3N1) . After radiochemotherapy, partial maxillectomy and upper neck dissection were performed. Nine months after the operation, however, CT revealed a RN metastasis on one side accompanied by involvement of cervical nodes. External radiotherapy to the neck disease was performed ; nevertheless, a RN metastasis on the other side was detected one month later by CT. Thus the disease was diagnosed as bilateral RN metastasis. The prognosis of bilateral RN metastasis in these cases was extremely poor : although the therapy had effects, the patients died with distant metastases about two months later. The causes of RN metastasis are assumed to be alterations of lymphatics induced by the neck dissection and/or tumor emboli. Thus it may be inferred that bilateral metastasis is the result of cross metastasis from tumor in the RN on the contralateral side or systemic metastasis. In conclusion, some cases of oral cancer may require diagnostic imaging of RN.