Introductory consultation with the anesthesia department. Intubation of the patient. The supraglottis is adjusted with the small bore tube. A penetrating defect can be seen at the base of the epiglottis, at the transition to the vallecula. The entire inner surface of the epiglottis is affected by an exophytic tumor, which here occupies the right side somewhat preferentially, but clearly crosses the midline. The support autoscopy is removed and the patient is switched to a spreading laryngoscope. This allows the tumor to be exposed reasonably well. Circular resection is now performed with the CO2 laser. Due to the slightly restricted view, the position of the spreading laryngoscope has to be changed once during the operation. The resection extends over the aryepiglottic fold on the right side into the vallecula and the prelaryngeal fat on both sides. The arytenoid cartilage on the right side is skeletonized on the inside. On the left side, the ary remains completely covered by mucosa and untouched. Due to an infestation of the detachment margin on the right ary, which could not be ruled out, a subsequent resection had to be performed during the operation, which was also sent in for final histological findings, as was the main specimen. Macroscopically, all the margins of the deposit appear free. The caudal margin refers to the pocket fold on the left side across the commissure to the pocket fold on the right side. However, 95% of the pocket folds are preserved. Removal of sedimentation margin samples in the caudal sedimentation area and anteriorly to the pre-epiglottic fat. All the specimens taken from the edge of the sedimentation area are sent for frozen section diagnostics. Here, the intraoperative findings are that there is high-grade dysplasia in the settling margin of the pocket fold on the right side and in the area of the commissure of the pocket folds, which is why the pathologists would recommend a resection here. This is done without any problems after the spreading laryngoscope has been inserted again with the CO2 laser. The new samples taken from the margins are sent for final histopathological diagnosis. If the wound is dry, removal of the spreading laryngoscope and support autoscopy. Repositioning of the patient for neck dissection. First injection of local anesthetic with adrenaline. Then skin incision, initially on the right side on the anterior edge of the sternocleidomastoid muscle. The dissection is performed subcutaneously far ventrally after an atheroma-like change becomes apparent here. This atheroma is removed from the subcutaneous tissue from the inside. A tiny skin injury is primarily treated with a suture. Subsequent layer-by-layer dissection in depth. Exposure and transection of the platysma. Exposure of the anterior edge of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the posterior belly of the digaster muscle. Exposure of the glandular capsule of the submandibular gland. Subsequently, the examination reveals a lymph node conglomerate far caudally and one in the area of the venous angle. Both lymph node conglomerates are dissected laterally down from the cervical vascular sheath after it has been exposed. Exposure of the cervical vascular sheath involves sparing the vagus nerve and all vascular structures. Displacement and, at the end of the operation, re-embedding of the vagus nerve in the sense of a neurolysis. After the lymph node conglomerates have been dissected laterally from the vein, the lateral neck preparation with all easily palpable nodes is removed. This is done while sparing the accessorius nerve. The hypoglossal nerve and accessorius nerve are lifted out of their bed in the sense of a neurolysis and re-embedded after relocation. The accessorius triangle is also removed. Clearing of the hypoglossal triangle and development of the anterior neck preparation. All branches of the internal jugular vein and external carotid artery are also protected. The preparation is sent together for diagnosis. Two-layer wound closure. Insertion of a Redon drainage. Application of a pressure dressing. Repositioning for neck dissection on the left side. This shows a cN0 neck status. Skin incision along the anterior edge of the sternocleidomastoid muscle. Dissection in depth. Dissection of the platysma. Exposure of all landmarks with the omohyoid muscle, the digaster muscle and the submandibular gland. Exposure and opening of the cervical vascular sheath. Long-distance dissection of the vagus nerve, hypoglossal nerve and accessorius nerve. All nerves are lifted out of their bed in the sense of a neurolysis and re-embedded. Release of the accessorius triangle and development of the entire lateral neck preaprate. The hypoglossal triangle is also released and then the entire anterior neck preparation is developed. Here too, the dissection is performed while sparing all branches of the internal jugular vein and external carotid artery. There are no enlarged lymph nodes. The entire preparation is also sent for histopathological examination. Insertion of a Redon drainage. Two-layer wound closure. Application of a pressure dressing. The result is a selective neck dissection of five levels on both sides. Due to the extent of the endolaryngeal resection and the potential swallowing problems to be expected, the decision was made to tracheotomize the patient. This is also performed after injection of local anesthetic with adrenaline pretracheally. Transverse skin incision and layer-by-layer preparation in depth. Exposure of the prelaryngeal and infralaryngeal muscles. This is separated in the middle. Exposure of the thyroid isthmus. This is clamped on both sides, severed and ligated. Exposure of the anterior surface of the trachea. The trachea is then opened between the 2nd and 3rd cartilage clasp. Dissection of the Björ flap. Then circular suturing of the tracheostoma with several holding sutures. Insertion of a tracheostomy tube. Final consultation with the anesthetist.