The development of infra-clavicular lymph node metastasis from head and neck squamous cell carcinoma is an uncommon event. We present a rare case of bilateral axillary nodal metastasis that developed in a patient previously treated for a primary ethmoidal squamous cell carcinoma. To our knowledge, there have only been five case reports in the English literature, accounting for a total of 10 patients, which documented a clinically apparent metastasis to axillary lymph nodes from various head and neck malignancies. Significantly however, the simultaneous ipsilateral and contralateral lymphatic spread of disease from a tumour in the para-nasal sinus, so as to involve bi-axillary nodes, has not been previously reported. We discuss the possible pathogenesis and the prognostic significance of this manifestation.