After appropriate preparation, a PEG is first inserted. After skin disinfection, subcutaneous infiltration with local anesthetic containing adrenaline in the area of the subsequent skin incision. Sterile washing and draping. Then initially perform the tracheostomy at the usual location. After skin incision, expose and undermine the thyroid isthmus. Open the trachea between the 3rd/4th tracheal clasp and insert the tube. Then complete the mucocutaneous anastomosis caudally. Then cut around the apron flap, which is successively folded up to the chin and fixed there. Then expose the prelaryngeal and prethyroid muscles, which are placed on the hyoid bone and folded caudally. Mobilize the hyoid bone also cranially, protecting the hypoglossal nerve and the lingual artery on both sides. Exposure of the thyroid cartilage and the thyrohyoid membrane. Exposure of the two lateral horns of the hyoid bone. Then open the hypopharynx at the left lateral hyoid horn. Then look at the right epiglottis margin, which is not infiltrated by the tumor. However, the tumor reaches about half of the epiglottis so that this is also resected. The tumor is then successively removed under vision using the monopolar knife with an appropriate safety margin. The resection encompasses the entire cranial vallecula. The base of the tongue is not affected. Caudally, the incision is made through the petiolus of the epiglottis without resection of parts of the thyroid cartilage. Ultimately, the tumor can be removed in its entirety in this way. Removal of marginal incisions circularly from the resection area, all of which prove to be tumor-free in the frozen section histological diagnosis. Subsequent transition to neck dissection on the left side. Here, a large metastasis is found in the area of region II, which infiltrates the sternocleidomastoid muscle and also affects the caudal part of the parotid gland. This is first dissected from medial to lateral. In this way, the internal jugular vein can be safely protected and extracted. After securing the vascular nerve sheath, the sternocleidomastoid muscle is removed caudally and the mass is dissected cranially with resection of the accessorius nerve, which is completely surrounded by tumor masses, and removed in toto with resection of the caudal parotid pole. Neck dissection is then performed in region I with removal of the submandibular gland and regions IV and V. Transition to neck dissection on the right side. Here, too, there are several metastatic nodes, but they are mobile and not infiltrating. This means that regions I-V are completely removed on this side while preserving all non-lymphatic structures. The operation is then transferred to <CLINICIAN_NAME>. The larynx is now moved cranially with several strong sutures on the lower jaw and positioned in the safe swallowing position under the base of the tongue. The prelaryngeal musculature is raised, completely covering the retaining sutures medially and refixed to the base of the tongue, thus forming the inner lining of the swallowing passage. Insertion of a Redon suction drain on both sides. Fold back the apron flap. Completion of the mucocutaneous anastomosis in the area of the tracheostoma and two-layer wound closure on both cervical sides. Sterile wound dressing. End of the operation, transfer of the patient to anesthesia. Conclusion: Resection of a vallecula carcinoma on the right side via an external pharyngotomy with resection of the entire vallecula including the epipglottis. Reconstruction of the swallowing pathway by thyropexy on the lower jaw. Simultaneous selective neck dissection of regions I-V on the right side and modified radical neck dissection on the left side with resection of the sternocleidomastoid muscle and the n. accessorius.