After transnasal intubation and preparation by the anesthesia colleagues, the patient is positioned. First inspection of the primary tumor region. As described above, the exophytic mass can be seen here, which completely occupies and consumes the uvula, clearly infiltrates the base of the uvula submucosally and extends over the soft palate in the direction of both upper tonsil poles, slightly shifted to the right with extensions to the anterior and posterior palatal arch on the left side. The tumor is now cut around with a good one cm safety margin. All sides of the left cranial tonsil pole are removed. Subtotal resection of the soft palate and for later graft positioning, performing a right tonsillectomy during tumor resection with partial resection of the posterior palatal arch on the right. The tumor is thread-marked for frozen section diagnostics and is shown here completely resected on the specimen in sano. Hemostasis and measurement of the defect. Neck dissection is performed first. A nasogastric feeding tube was inserted beforehand. Due to good short-term and long-term swallowing prognosis and cirrhosis of the liver, no PEG was inserted. Start with neck dissection on the left side. Submandibular incision. Cutting through skin and subcutaneous tissue. Exposure, transection and dissection of the platysma. Exposure of the sternocleidomastoid muscle and preservation of the external jugular vein and auricular nerve. Exposure of the omohyoid muscle. Release of the submandibular gland, taking the caudal capsule with it. Exposure of the digastric muscle and preservation of the facial vein. Removal of the anterior neck preparation with exposure and preservation of the superior thyroid artery, the cervical artery and the hypoglossal nerve. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Clearance of the posterior neck preparation, limiting the neck extension towards level V. Exposure and preservation of the cervical plexus roots. Exposure of the common carotid artery and the vagus nerve. Macroscopically no evidence of metastasis on this side. Wound irrigation with Ringer's solution, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Turn to the opposite side. Same procedure here in principle. Extension of the expansion in the direction of the accessorius triangle and, after level V, complete exposure and removal of the structures already described on the opposite side. No evidence of lymphogenic metastasis. Strong vascular condition. Dissection and conditioning of the superior thyroid artery and the clearly branched facial vein. Resection of the digastric muscle. Formation of a pharyngocutaneous connection approx. 3 transverse fingers wide for graft positioning. Careful hemostasis. Then lift the radialis graft from the left. Perform the elevation in bloodlessness. Marking of a graft measuring 12 x 5.5 cm in total, confluent for the tonsil region and soft tissue. Radial incision. Incision of the graft. Exposure of the brachioradialis muscle. Exposing and securing the ramus superficialis nervi radialis. Distal exposure and transection of the vascular pedicle. Strictly subfascial release. Exposure of the flexor carpi ulnaris muscle. Elevation of the graft. Conditioning on the vascular pedicle. Exposure of the radial artery and securing of the ulnar artery. Dissection of the venous confluence and conditioning on a strong vein of the deep venous system with connection to the superficial. Reopening of the tourniquet. Regular blood flow to the hand and regular blood flow to the graft. Careful hemostasis in the area of the graft and in the area of the forearm. Subsequently, after removal of the preparation, careful two-layer wound closure and incorporation of the full-thickness skin graft harvested from the right groin. Subsequent positioning of the graft enorally. Successive transoral insertion. Overall good fit and sufficient soft palate reconstruction. Pedicle positioning. Performing the arterial anastomosis with 8.0 Ethilon, after conditioning the pedicle vessels. Performing the venous anastomosis with the coupler system using a size 4.0 coupler. Subsequent correct pedicle position. Positive spreading phenomenon and regular enoral graft perfusion, so that after careful wound inspection, a 10 Redon drain is inserted and the wound is carefully closed in two layers. A tracheotomy was not performed due to the completely narrow enoral conditions. The patient is transferred to the intensive care unit for one night on mechanical ventilation. Conclusion: Intraoperatively in sano resected cT2 cN0 uvular carcinoma. Postoperative careful graft monitoring. If the graft heals properly, a gradual diet can be started on the 7th postoperative day. Please continue antibiotics for 24 hours. Presentation at our interdisciplinary tumor conference to discuss adjuvant therapy.