Review of CT scans and clinical records of 46 patients with known or suspected recurrent tumor of the upper aerodigestive tract and neck has afforded a new radiographic perspective on the natural history of these neoplasms. The 46 patients included a group of 34 patients with squamous cell carcinoma of the upper aerodigestive tract and a group of nine patients with nonsquamous malignancies metastatic to the neck. Recurrences were evaluated for interval to recurrence, site of recurrence, and CT impact on the clinical management of the recurrent tumor. Results of the study indicate that CT detects tumor beyond the limits of physical examination in 32% of cases and in doing so may alter radiotherapy ports or the surgical approach. CT was the only means of demonstrating recurrent squamous cell carcinoma in 27% of that patient group. Moreover, the study shows the potential of CT to reduce delay in diagnosis in both patient groups, but most dramatically in those patients with nonsquamous malignancies. Recommendations for CT follow-up in this patient population are made based on this experience.