Which anatomical feature explains why even a small T1 supraglottic carcinoma requires bilateral elective treatment of the neck, whereas a comparable glottic tumour does not?
- A Rich bilateral lymphatic drainage reflecting the supraglottis separate embryological origin ✓
- B Direct contiguous spread to both arytenoids through the ventricle
- C Venous drainage of the supraglottis into both internal jugular systems
- D Communication of supraglottic lymphatics with the subglottic plexus across the conus elasticus
Correct answer: A. Rich bilateral lymphatic drainage reflecting the supraglottis separate embryological origin
Explanation
The supraglottis develops from the buccopharyngeal primordium while the glottis arises from the tracheobronchial bud, so their lymphatic territories never communicate. Abundant, horizontally oriented lymphatics drain the supraglottis bilaterally to levels II and III, producing a high rate of occult bilateral disease even in small tumours. The glottis itself is nearly devoid of lymphatics, which is why true cord lesions metastasise very late.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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