Step 1 of 14
Presentation & Airway Assessment
Sore throat · dysphagia · referred otalgia · neck mass + airway-compromise triage
Supraglottic carcinoma is insidious — it arises above the vocal cords and rarely changes the voice early, so it presents late with vague throat symptoms. The common presentations are a persistent sore throat, dysphagia, odynophagia, referred otalgia (via the vagus), globus, a muffled "hot-potato" voice, a neck mass, weight loss, haemoptysis, and aspiration. A neck node is frequently the first sign, reflecting the rich lymphatic drainage of the supraglottis.
Before the elective work-up, the airway is assessed. Airway compromise — stridor, respiratory distress, hypoxia, progressive obstruction, or bilateral arytenoid dysfunction — demands a planned, controlled airway: awake fibreoptic intubation or a controlled tracheostomy, with ICU monitoring. A crash emergency tracheostomy in an obstructing supraglottic tumour is avoided wherever possible — the distorted, bleeding, oedematous field is hazardous. Once the airway is secure, staging proceeds; a stable airway continues to standard evaluation.
- Symptoms — sore throat, dysphagia, odynophagia, referred otalgia, globus, muffled voice
- Symptoms — neck mass (often first sign), weight loss, haemoptysis, aspiration
- Airway compromise — stridor, distress, hypoxia, progressive obstruction, bilateral arytenoid dysfunction
- Secure — awake fibreoptic intubation / controlled tracheostomy + ICU monitoring
- Avoid crash emergency tracheostomy in an obstructing supraglottic tumour
Key statistics
Supraglottic SCC — population cohort
22,675 cases
The largest population-based supraglottic-SCC series (22,675 cases) anchors the late, node-prone presentation and the survival impact of stage and treatment modality.
★ High-yield pearls (chapter-wide)
- Supraglottic cancer presents late and vaguely — a persistent sore throat, referred otalgia, or a neck node in a smoker is supraglottic carcinoma until the larynx is scoped.
- The supraglottis has a rich, bilateral lymphatic network — node metastasis is common and frequently bilateral, so both necks are treated even when N0.
- Pulmonary reserve is the gatekeeper for conservation surgery — a supraglottic laryngectomy patient must be able to tolerate and clear the aspiration that follows; assess PFTs before promising organ preservation.
- Larynx preservation is not functional-larynx preservation — a chronically aspirating supraglottic remnant can be worse than a well-rehabilitated total laryngectomy.
- Map the danger subsites at direct laryngoscopy — pyriform apex, anterior commissure, both arytenoids, paraglottic space, and tongue-base extent decide whether conservation surgery is even possible.
- Bilateral arytenoid involvement, pyriform-apex disease, paraglottic-space or thyroid/cricoid cartilage invasion, and extension past the circumvallate papillae each contraindicate supraglottic laryngectomy — they route to total laryngectomy or chemoradiotherapy.
- Airway compromise is managed with a planned, controlled airway (awake fibreoptic or controlled tracheostomy) — avoid a crash emergency tracheostomy in an obstructing supraglottic tumour.
- Positive margins or extranodal extension on final pathology are the two findings that turn adjuvant radiotherapy into concurrent cisplatin chemoradiotherapy.
- The supraglottic swallow (breath-hold, swallow, cough, re-swallow) is the cornerstone of rehabilitation after conservation surgery — teach it before operating, not after.
- Screen relentlessly for the second aerodigestive primary — the same tobacco-and-alcohol field that caused the supraglottic cancer threatens the lung and oesophagus for life.
Evidence base
3 sources- HIGH
Steuer CE, El-Deiry M, Parks JR · CA Cancer J Clin · 2017ReviewPMID 27898173
Comprehensive laryngeal-cancer review anchoring epidemiology, staging, and management.
- MOD
Patel TD, Echanique KA, Yip C · Laryngoscope · 2019Population-based studyPMID 30536822
Largest supraglottic-SCC population series — anchors its presentation, nodal behaviour, and outcomes.
- MOD
Obid R, Redlich M, Tomeh C · Oral Maxillofac Surg Clin North Am · 2019ReviewPMID 30449522
Practical treatment review across laryngeal subsites and stages.
Decision tree
The triage screen is the first gate. Classification routes the stable patient to one of the aetiology-keyed pathways below. Cross-cut cards capture the chapter's must-not-miss rules.