Aims: We compared the prognostic utility of sentinel node biopsy (SNB) and elective neck dissection (END) in patients with early (T1–2) oral cavity squamous cell carcinoma (OSCC) and clinically N0 necks. Methods: We searched the PubMed, SCOPUS, Embase, Web of Science, and Cochrane library databases up to March 2022. The hazard ratios (HRs), Kaplan–Meier curves, p-values, and survival outcomes were extracted, along with all study characteristics. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Twelve studies involving 10,583 patients were finally included. We found no significant differences in overall survival (OS) (HR = 1.1226; 95% confidence interval [CI]: 0.9263; 1.3604), disease-free survival (DFS) (HR = 1.0797; 95% CI: 0.8765; 1.3300) or disease-specific survival (DSS) (HR = 0.8652; 95% CI: 0.6531; 1.1462) between the two groups. Heterogeneity was not detected in pooled OS, DFS, and DSS analyses (all I2 < 50). In subgroup analyses by follow-up period (3, 5, and 10 years), SNB and END had similar prognostic value. Conclusions: We found no significant difference in OS, DFS, or DSS between patients with early OSCC and clinical N0 necks evaluated via SNB and END, suggesting that SNB might be a valuable alternative to END for the management of early stage clinically node-negative OSCC.