The purpose of this study was to investigate the incidence of metastases to retropharyngeal (RP) nodes and to evaluate the results of RP node dissections in advanced carcinomas of the oropharynx and hypopharynx. Twenty-four patients with stage III/IV squamous cell carcinomas of the oropharynx and hypopharynx were treated with standard resection, RP node dissection up to the base of the skull, and radiotherapy of 50 Gy postoperatively to the RP space if RP nodes were involved. Fifty percent (12 of 24) of the patients had positive RP nodes, 36% (4/11) with carcinoma of the oropharynx and 62% (8/13) with carcinoma of the hypopharynx. Six patients had recurrences and of them five died of the disease. The cumulative 3-year survival rate (Kaplan-Meier) was 53%. Because of the high incidence of metastases to RP nodes in stage III/IV oropharynx and hypopharyngeal cancers, we recommend the adding of RP node dissection in these patients.