In the patient, a differentiated squamous cell carcinoma in the right hypopharyngeal region had already been histologically confirmed externally.  <2013> the extension was determined. Suspicion of tumor growth towards the cervical vascular sheath. Sonographic and computed tomographic cN0 and cM0 status. In our interdisciplinary tumor conference, primary surgical treatment was recommended; due to the growth, an external approach with flap coverage if necessary was favoured.