First, panendoscopy and confirmation of the suspected diagnosis of cT2 tonsillar carcinoma. This shows an exophytic mass of the tonsil in the area of the upper tonsil pole. This spreads from here to the soft palate and reaches the base of the uvula on the right side. The lower tonsil pole appears tumor-free. However, there is a fish bone in the tonsil, which is removed. When looking forward with the small bore tube in the direction of the hypopharynx and larynx, the mucosal conditions are otherwise normal and inconspicuous. The hypopharynx in the sense of the piriform sinus can be fully unfolded on both sides and the postcricoid region as well as the esophageal entrance plane are inconspicuous. The endolaryngeal mucosa is also unremarkable. Rigid tracheobronchoscopy had already been performed during intubation. Here too, the subglottic and tracheal mucosa up to the main bronchi was unremarkable. After repositioning the patient, the flexible esophagoscope was inserted and the esophagus was visualized. This reveals a regular fold relief. With positive diaphanoscopy and a positive tent phenomenon, the PEG tube can then be inserted without any problems using the thread pull-through method. On reflection, the esophageal mucosa was carefully inspected again, which also proved to be non-irritating and unremarkable. This confirms the suspected diagnosis of an externally confirmed cT2 tonsil carcinoma, which is why the patient is now transferred for tumor tonsillectomy and neck dissection on both sides: First, skin incision along the soft palate and dissection of the anterior palatal arch caudally. At the lower pole, first expose the tonsil capsule. There is no evidence of tumor growth beyond the capsule. Therefore, expose the caudal pole vessels, which are then carefully coagulated and cut. The tonsil is then removed at the lower pole and dissected cranially. Then dissect into the soft tissue of the oropharyngeal side wall and the muscles of the palate. Maintain a sufficient safety distance of about 8 mm from the exophytic change in the upper pole of the tonsil. The resection is then performed up to the middle of the base of the uvula, which is then also resected. However, the tip of the uvula remains intact during the resection. After further posterior dissection, the tonsil can then be completely removed together with the exophytic change. Suture marking of the preparation is now carried out outside the site in the area of the margin of the abscess at the base of the uvula and in the area of the abscess margins in the area of the wound base at the caudal and cranial lateral tonsil pole. Circularly, the mucosa of the tonsil is also macroscopically inconspicuous on the preparation. The entire preparation is then sent for frozen section diagnostics. Intraoperatively, all suture markings are found to be tumor-free and the R0 resection is confirmed on the specimen. After subtle hemostasis, the wound surface of the uvula is fixed to the anterior soft palate in the area of the margin on the right side with several sutures. Then, after checking the bleeding again, removal of the mouth retractor and repositioning of the patient for neck dissection: After injection of local anesthetic with adrenaline in the area of the anterior edge of the sternocleidomastoid muscle on both sides of the neck, first abjode and position the patient. Then start the neck dissection on the right side with an incision along the anterior border of the sternocleidomastoid muscle. After cutting through the platysma, dissection in layers in depth. Exposure of the cervical vascular sheath. Exposure of the omohyoid muscle and the digaster muscle. Finding and protecting the accessorius nerve. A large lymph node conglomerate can be seen here in the area of the venous angle. Therefore, very careful dissection along the cervical vascular sheath and sharp dissection of the lymph node conglomerate from the cervical vascular sheath. All structures of the cervical vascular sheath are spared. Then develop the entire lateral neck preparation from the accessorius triangle to the level of the omohyoid muscle. Then evacuate the hypoglossal triangle while sparing the branches of the external carotid artery and internal jugular artery as well as the hypoglossal nerve. The caudal medial neck preparation is then also completely dissected, sparing the vascular branches. The entire neck preparation of the right side is then sent for histological examination. Subsequent subtle hemostasis and insertion of the Redon drainage. Then two-layer wound closure and repositioning of the patient for neck dissection on the left side: here too, skin incision along the anterior edge of the sternocleidomastoid muscle. Dissection in depth in layers until the cervical sheath is exposed. Then dissect and expose the omohyoid muscle and digaster muscle. Locate and protect the accessorius nerve. Then dissection of the entire lateral neck preparation from the accessorius triangle to the level of the omohyoid muscle. Then clearing of the hypoglossal triangle. Here too, a large lymph node conglomerate can be seen in the area of the venous angle, which must be dissected sharply away from the cervical vascular sheath during the dissection of the hypoglossal triangle. The entire dissection is carried out while protecting the outlets of the internal jugular vein and external carotid artery. Finally, dissection of the caudal medial preparation, also with protection of the vascular outlets. After renewed subtle hemostasis, a Redon drain was also inserted here and then the wound was closed in two layers. The overall result is a selective neck dissection on both sides of levels II to V. At the end of the operation, the wound is checked again enorally. If the wound is dry, the procedure is then completed. Further procedure depending on the histopathological findings.