Preepiglottic space invasion in "early" epiglottic cancer

The tendency of epiglottic cancer to invade the preepiglottic space and the significance of this invasion was evaluated in 36 surgical specimens of epiglottic carcinoma originally staged T1 or T2. None of the 9 lesions originating above the hyoepiglottic ligament invaded the preepiglottic space. Twenty-four of the 27 (89%) lesions originating below the hyoepiglottic ligament showed invasion of the preepiglottic space and were clinically understaged. Of the 3 infrahyoid lesions showing no invasion of the preepiglottic space, 1 was a verrucous carcinoma and another was a mucoepidermoid carcinoma arising on the petiole. All other lesions were squamous cell carcinoma. In 12 of the 24 patients (50%) with preepiglottic space invasion, cervical node metastasis was present despite the preoperative staging of T1 or T2.