The subglottis is the laryngeal subsite with the worst prognosis for carcinoma despite being rare. The primary reason for late diagnosis and poor prognosis is:
- A The subglottis is poorly visualised on indirect laryngoscopy and produces no early symptoms, combined with rich lymphatic drainage to Delphian and paratracheal nodes ✓
- B The subglottis lacks mucosal lymphatics, allowing deep submucosal spread before lymph node involvement
- C Subglottic tumours produce early dysphagia due to their proximity to the cricopharyngeus
- D Subglottic tumours are typically adenocarcinomas, which have inherently worse prognosis than squamous cell type
Correct answer: A. The subglottis is poorly visualised on indirect laryngoscopy and produces no early symptoms, combined with rich lymphatic drainage to Delphian and paratracheal nodes
Explanation
Subglottic carcinoma (arising 5 mm below the free vocal cord edge) is silent in early stages — it does not produce hoarseness (cords are uninvolved) and causes stridor only with significant luminal narrowing. Combined with rich lymphatic drainage anteriorly to the Delphian (pre-laryngeal/pre-tracheal) node and paratracheal chain, nodal spread occurs early (20% at diagnosis even in T1). This triad of silent presentation, late stridor, and early nodal spread explains the poor prognosis. All laryngeal carcinomas are predominantly squamous cell type.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.