The patient is first taken to the operating room and prepared by the anesthesia colleagues. Tracheotomy: Horizontal skin incision at the level of the cricoid. Separation of the skin and subcutaneous tissue. Identification of the infralaryngeal musculature and division of the musculature in the midline. Sharp dissection of the cricoid cartilage. Identification of the thyroid isthmus and undermining of the isthmus with a clamp. Separation of the isthmus after bipolar coagulation and identification of the anterior tracheal wall. Creation of a visor tracheotomy between the 2nd and 3rd tracheal cartilage. Epithelialization of the tracheostoma in the usual manner and insertion of a 9-gauge cannula. Subsequent attempt at PEG insertion. PEG insertion not possible, therefore secondary insertion by surgical or internal medicine colleagues if diaphanoscopy is insufficient. Subsequent transoral tumor resection. Positioning of the head. Insertion with the McIvor oral spatula. Successive resection of the tumor with a safety margin of 1 to 1.5 cm on all sides. Here too, the mucosa is first pushed away from the hard palate, the palatal bone is already resected in the marginal area. The entire tonsil with the adjacent palatal arch area falls from left to right. The tumor is successfully removed in toto with a macroscopic safety margin on all sides. The tumor is thread-marked. A marginal sample is taken from the mucosal area in the posterior palatal arch at the border to the vomer. The specimen and marginal sample are sent for frozen section. In the frozen section, according to the pathology department, there is still a CIS in the caudal region on both sides, i.e. in the area of the mucosa below the tonsil lobe. Equally uncertain situation with CIS that cannot be ruled out in the area of the marginal sample in the direction of the vomer. Therefore, extensive resection of a mucosal strip in the area of the mucosal transition from the lower tonsil pole towards the hypopharynx. This is done from both sides, whereby the marginal samples are sent in 2 parts. Likewise, clear resection with further removal of the vomer and subsequent resection of the soft tissue behind and below it. All soft tissue and bone parts are sent for frozen section. No more carcinoma in situ infiltrates detectable here. Therefore now R0 resection. Neck dissection on the right side by <CLINICIAN_NAME>: skin incision and dissection through the subcutaneous fatty tissue. Exposure of the platysma and subplatysmal blunt dissection. Finding the external jugular vein. This is extremely thick and has a bifurcation. Ligation of the medial part and preservation and retraction of the lateral part. Dissection of the anterior margin of the sternocleidomastoid muscle and identification of the omohyoid muscle. Dissection along this and exposure of the submandibular muscle. Elevation of the submandibular glenoid with the Langenbeck and lateral dissection on the digastric muscle. Identification of the accessorius nerve and preservation of this. Now dissect the cervical vascular sheath and dissect the internal jugular vein cranially. Preservation of the facial nerve and finding and preserving the hypoglossal nerve. Now successive removal of the lateral neck preparation while sparing the accessorius nerve and the plexus branches. Identification of the vagus nerve and protection of this. Now also successive removal of the medial neck preparation. There is no evidence of bleeding. Insertion of a Redon drainage and two-layer wound closure. Neck dissection on the left side through <CLINICIAN_NAME>: Skin incision on the anterior edge of the sternocleidomastoid muscle. Separation of the cutaneous and subcutaneous tissue. Separation of the platysma. Subplatysmal dissection of a skin flap. Identification of the external jugular vein and the auricular nerve. The nerve can be pushed upwards and preserved, the external jugular vein is ligated and cut. Dissection along the sternocleidomastoid muscle in depth with constant use of bipolar coagulation. Identification of the deep cervical fascia and the plexus branches of the cervical plexus as well as the accessorius nerve. Identification of the omohyoid muscle and dissection along the muscle medially to the hyoid bone. Identification of the posterior digastric venter muscle and dissection along the muscle anteriorly to the hyoid bone. The cervical lymph node regions II, III and IV as well as I b are removed after free dissection of the submandibular gland and removal of the surrounding lymph nodes. The neurovascular structures can be preserved. No major bleeding and no injury to the accessorius nerve. For the planned flap anastomosis, the superior thyroid artery is conditioned and dissected free and the internal jugular vein is dissected free in a circular fashion. The latissimus dorsi flap is then removed. First position the patient so that the left latissimus dorsi flap can be removed accordingly. (<CLINICIAN_NAME>, maxillofacial surgery). The flap is then removed and a vascular connection is made, also by the anesthesia colleagues. Skin closure in the cervical area on both sides in a typical manner with insertion of a Redon drain in each case. Careful hemostasis and irrigation beforehand. Further inspection of the flap enorally. This is vital. Completion of the procedure without complications. Patient goes to the Medical Intensive Care Unit 1 for monitoring. Please continue antibiotic treatment with Unacid, which was started intraoperatively, for 1 week. Flap control according to the scheme for 5 days. Nutrition via the intraoperatively inserted gastric tube. Please arrange for a PEG to be inserted at intervals by the surgical or anesthesia colleagues once the wound has healed. After receiving the final histology, the patient will be presented at our interdisciplinary tumor conference. Overall cT3-4 oropharyngeal carcinoma in the palatal arch area.