The primary treatment for nasopharyngeal carcinoma is radiotherapy. Despite optimal treatment the incidence of recurrent persistent or recurrent regional disease is significant. It is believed that recurrent regional disease is usually associated with local disease. Recurrent nodal disease commonly involves the subdigastric and upper jugular region and submental involvement is less common. This study includes 25 patients who had palpable submental nodes 2 years or more after radiotherapy. Five of the seven patients with proven malignant submental nodal recurrence of nasopharyngeal carcinoma had no other evidence of disease. Ultrasound accurately identified enlarged nodes and correctly predicted involvement. The ultrasound appearances of these nodes and their impact on management and prognosis is discussed.