Primary subglottic cancer is a very rare condition. In almost cases, a delayed diagnosis of subglottic cancer is made in patients complaining of hoarseness or dyspnea. This often leads to a poor prognosis. The subglottic tumor spreads to invade deep structures, including the muscles or interstitial tissue. We reported four cases of subglottic cancer that were observed from 1986 to 2008. This number constitutes 1.0% of all the laryngeal cancers that were observed during this period. Three cases were treated with total laryngectomy with neck dissection. The remaining case was treated with radiotherapy alone. The overall five-year- survival rate was 75%. In two cases, horizontal serial pathological sections showed tumor invasion to thyro-arythenoid muscle （Case 1）and invasion of the thyroid cartilage across the anterior commissure of the larynx （Case 2）. We stressed the necessity of total laryngectomy with hemi-thyroidectomy and unilateral neck dissection including dissection of the paratracheal lymph node, as the treatment for subglottic cancer according to the characterization of its pattern of spread.
