Introductory consultation with the anesthetist. Positioning of the patient and insertion of the mouth guard. Approximation of the tongue. An exophytic mass on the edge of the tongue with a dorsal leuoplakia is revealed. This mass is first incised with the electric needle and the resection margins are determined. It can be seen that the mass is very superficial, so that the body of the tongue is only covered superficially. The resection depth reaches a maximum of around 1 cm. The resection is performed successively and extremely carefully with subtle hemostasis and ligation of some larger arterial vessels. If the wound is dry, representative samples are taken from the margins, all of which are found to be tumor-free in the frozen section. This therefore appears to be an R0 resection. The tumor specimen is sent for final histopathological assessment in thread-reinforced form. Infiltration of the tongue with a long-acting local anesthetic. The edge of the tongue is then closed with inverted sutures. After aspiration of blood residue, removal of the mouth block. Repositioning of the patient for neck dissection on both sides. Injection of local anesthetic with adrenaline cervically on both sides. Start on the right side, where numerous suspicious lumps were found on ultrasound. Incision along the sternocleidomastoid muscle on the right side. Exposure of the platysma. Dissection of the platysma and layer-by-layer dissection in depth. Exposure of the omohyoid muscle and digaster muscle. Insertion of the retractors. A large lymph node conglomerate can be seen in the venous angle. Exposure of the cervical vascular sheath and long dissection of the same. Long-distance dissection and exposure of the accessorius nerve. Performing a neurolysis and re-embedding of the accessory nerve at the end of the operation. Similarly, long dissection of the vagus nerve with displacement, neurolysis and re-embedding. Resection of the lateral neck preparation from level IIa caudally to the level of the omohyoid muscle. All branches of the internal jugular vein and external carotid artery can be spared. Clearing of the hypoglossal triangle. Long-distance dissection, relocation and re-embedding of the hypoglossal nerve in the sense of a neurolysis. Here too, all vascular and nerve structures are preserved. Removal of the level III and IV anterior neck preparation. Exposure of the capsule of the submandibular gland and palpation in level I, where no suspicious masses can be palpated. Perform subtle hemostasis. Insertion of a size 10 Redon drain and two-layer wound closure. Application of a pressure bandage. Repositioning for neck dissection on the left side. Here only sonographically enlarged, slightly suspicious nodes are visible. Here too, the incision is made along the anterior edge of the sternocleidomastoid muscle. Dissection in depth in layers and exposure of the cervical vascular sheath. This is also dissected over a long distance with long-distance exposure, displacement and re-embedding of the vagus nerve in the sense of a neurolysis. Long-distance dissection, exposure, displacement and re-embedding of the accessory nerve in the sense of a neurolysis. In the course of the same dissection of the hypoglossal nerve, presentation, displacement and re-embedding of the hypoglossal nerve in the sense of a neurolysis. Clearing of levels II and III. Several enlarged but macroscopically unsuspicious lymph nodes can be seen in the area of the accessorius triangle and venous angle. Here too, the specimen is sent for histopathological examination. After subtle hemostasis, insertion of a Redon drain. Two-layer wound closure. Application of a pressure bandage. Final consultation with the anesthetist. Completion of the procedure. Further procedure depending on the final histopathological findings.