Introductory consultation with the anesthetist. Adjustment of the pharynx with the laryngoscope. Insertion of the flexible esophagoscope. Advance into the stomach: inconspicuous conditions there. If diaphanoscopy is good, PEG insertion in the usual way using the thread pull-through method. No bleeding. Perioperative administration of Unacid. Please continue this for a few days postoperatively. Hypopharyngoscopy performed again: After adjustment with the small water tube, the tumor at the entrance in the hypopharynx on the left can be seen very clearly, which is relatively easy to move and can be pushed away from the arytenoid cartilage. Decision to perform a neck dissection on both sides with tracheotomy and lateral pharyngotomy with tumor extirpation. Repositioning of the patient and skin disinfection. Infiltration anesthesia in the area of the right and left side of the neck. Start on the left. Marking of a platysmal flap. Cut around the platysmal flap and dissect it as far as the submandibular gland. At the same time, perform the neck dissection, cutting through the subcutaneous tissue. Exposure of the sternocleidomastoid muscle after dissection of the platysmal flap medially. Exposure of the internal jugular vein, the facial vein, which remains intact. Exposure, displacement, neurolysis and re-embedding of the vagus nerve and the accessorius nerve. Exposure of the posterior digastric venter muscle. Dissection of the posterior neck preparation, first clearing level IIb, then continuing cranially to IV beginning V. After detachment and transection of the omohyoid muscle, finally transection of the fatty tissue and its supraclavicular transection. Removal of the posterior neck preparation. Now dissect anteriorly. Removal of the capsule of the submandibular gland. Exposure, displacement, neurolysis and re-embedding of the hypoglossal nerve. Exposure of the superior thyroid artery and the superior laryngeal nerve. Preparation of the anterior neck specimen and also submission for definitive histology. Exposure of the upper edge of the thyroid cartilage and the posterior edge. Removal of the upper horn of the thyroid cartilage and detachment of the piriform sinus from the thyroid cartilage. Resection of part of the thyroid cartilage. Entering the pharynx. Perform a lateral pharyngotomy below the hyoid bone. The tumor can be clearly seen at the entrance to the hypopharynx. It is circumcised in a circular fashion while sparing the laryngeal structures. The arytenoid hump is clearly visible but remains intact and part of the mucosa of the arytenoid hump must also be removed. In some cases, resection of part of the aryepiglottic fold. Removal of circular margin samples. These are all found to be tumor-free in the frozen section. Due to the relatively circumscribed defect, it is not necessary to create a flap. The platysmal flap is therefore moved back later. A primary multi-layered wound closure of the mucosa is now performed. This is very successful. The thyroid gland is dissected caudally, set down at the caudal pole and swung upwards to additionally reinforce the pharynx on this side and is stitched directly onto the pharyngeal suture. Extensive hemostasis with bipolar coagulation and irrigation with H2O2 and Ringer's solution. No more bleeding. Insertion of a Redon drain. Repositioning of the platysmal flap. Subcutaneous sutures, skin suture. Pressure bandage. Repositioning for neck dissection on the opposite side. Infiltration anesthesia. Skin incision on the anterior edge of the sternocleidomastoid muscle. Exposure of the muscle. Exposure of the internal jugular vein. Exposure, displacement, neurolysis and re-embedding of the accessorius nerve. Exposure of the posterior digastric venter muscle. Exposure, displacement, neurolysis and re-embedding of the vagus nerve. Development of the posterior neck preparation from cranial to caudal to the omohyoid muscle. Set down there and reposition the fatty tissue. Dissection of the anterior neck preparation, exposing the hypoglossal nerve. Displacement, neurolysis and re-embedding of the hypoglossal nerve. Dissection with the capsule of the submandibular gland and sparing of the facial vein. Complete evacuation of the anterior part of the neck. Hemostasis with H2O2 and bipolar coagulation. Irrigation with Ringer's solution. No more bleeding. Insertion of a Redon drain. Subcutaneous suture, skin suture and pressure dressing. Performing the tracheotomy: To do this, make a star-shaped incision over the jugulum. Dissection of the subcutaneous tissue. Exposure of the linea alba. Exposure of the thyroid isthmus. Separation and incision of the same. Exposure of the anterior tracheal wall and between the 2nd and 3rd tracheal cartilage now entering the trachea. Formation of a Björk flap. Epithelialization of the tracheostoma. Re-intubation of the patient and insertion of an 8-gauge Rügheimer cannula, which is currently blocked. The Rügheimer cannula is fixed to the skin with three sutures. No bleeding at the end of the procedure, no other special features. Detailed consultation with the anesthetist. The patient is transferred to the intensive care unit for monitoring.