A 58-year-old male smoker presents with hoarseness of six months' duration. Endoscopy shows a carcinoma confined to the true vocal cord without cord fixation. Compared with supraglottic tumours, this lesion metastasises late because:

• A The true vocal cords are richly supplied with lymphatics that drain bilaterally
• B The recurrent laryngeal nerve blocks lymphatic flow across the glottis
• C Glottic tumours spread preferentially through the cricothyroid membrane to mediastinal nodes
• D The true vocal cords are almost devoid of lymphatics, whereas the supraglottis is richly supplied ✓

Explanation

The true vocal cords have a very sparse lymphatic supply, so glottic carcinoma remains localised for long periods and presents early with hoarseness, giving excellent cure rates. The supraglottis and subglottis have abundant lymphatics draining to the deep cervical and prelaryngeal nodes respectively, which explains their earlier nodal spread. This lymphatic poverty of the glottis is the standard anatomical teaching tested at postgraduate level.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.