Induction of anesthesia by the anesthesiologist. Transnasal intubation by anesthesia colleagues. Sterile washing and draping. Start with transoral tumor resection. For this purpose, the tongue is snared and the tumor region is cut around with the monopolar needle in the area of the edge of the tongue to the base of the tongue. Then switch to the neck, as an overview is no longer guaranteed and the main tumor mass is located in the base of the tongue; instead, a skin incision is made in a transverse skin fold 3 transverse fingers below the lower jaw. Exposure of the platysma. Separation of the platysma. Dissection of the platysma cranially and caudally. Exposure of the submandibular gland, then the anterior margin of the sternocleidomastoid muscle, the omohyoid muscle, the cervical vascular sheath and the accessorius nerve. Levels II to V a are then dissected out, sparing the plexus branches. The submandibular gland is detached and the digastric muscle is cut. The tumor clearly bulges in the area of the floor of the mouth and level II and can also be palpated here. Except for the external jugular vein, all neck vessels can be preserved. Now tanscervical tumor resection. To do this, grasp the tumor and subcircumcise it. Perform a pharyngotomy and enter the oral cavity. Further tumor resection using the pull-through technique. This allows the tumor to be completely resected en bloc. In the area of the glossotonsillar groove and in the area of the edge of the tongue, the tumor is very narrowly resected macroscopically, so a generous resection is performed here and a marginal sample is taken. Unfortunately, the resected frozen section still showed invasive carcinoma in the area of the edge of the tongue. Due to an organizational oversight, the marginal sample from the edge of the tongue that was taken after the resection was unfortunately not included in the frozen section. Therefore, another resection is performed here and a marginal sample is taken, which is ultimately tumor-free, final R0 situation. Repositioning for neck dissection on the right side and tracheotomy. Tracheotomy dictation <CLINICIAN_NAME>: Marking of the landmarks (thyroid incisura, cricoid cartilage and jugulum). Mark the skin incision approximately 0.5 cm below the cricoid cartilage. Now start the incision and cut through the subcutaneous fatty tissue. This is carefully bipolarized. Insert two sharp retractors and dissect through the entire subcutaneous fatty tissue. Dissection on the prelaryngeal musculature. The linea alba is sought out and dissection continues in this area. The prelaryngeal musculature is released in the middle and pushed bluntly to both sides. Locate the capsule of the thyroid gland. Here ligation of a vein. The thyroid gland is ligated and the remaining ends are bipolarized. There is hemostasis. Exposure of the trachea. The trachea is now opened between the second and third tracheal clips. The incision is extended further to the right and left. A Björk flap is not applied. Suture in the Mersilene sutures. With the Kilian speculum, reintubation is performed without any problems, so that an 8 mm tube is now used for ventilation during the operation. Neck dissection on the right. Skin incision three transverse fingers below the lower jaw in a skin fold. Exposure of the platysma and dissection and preparation of the platysma cranially and caudally. Exposure of the anterior border of the sternocleidomastoid muscle, the submandibular gland, the omohyoid muscle and the digastric muscle. Clearing out the neck levels II a to V a, while sparing the plexus branches. All vessels, including the external jugular vein, can be preserved. Lifting the radial artery graft. First palpate the radial artery and mark the graft 12 x 8 cm. Then unwrap the forearm and further dissection in bloodlessness. Cut around the graft in the skin area. Incision up to the crook of the elbow. Exposure of the brachioradialis muscle. Exposure of the venous star in the antecubital fossa. Exposure of the superficial ramus, radial nerve, which divides into two main branches. Both main branches can be preserved. Exposure of the radial artery. Clamping and severing of the radial artery. Ligation. Detachment of the graft from the tendons and release of the pedicle in the usual manner. Deposition of the radialis graft with a superficial and a deep vein. Suturing of the graft first from the transoral side, starting at the soft palate, then along the floor of the mouth. The graft must be attached to the teeth and the alveolar ridge, as there is not enough mucosal remnant in the rest of the floor of the mouth. Further suturing from transcervically in the area of the pharynx and the vallecula and finally reconstruction of the tongue with the remainder of the transoral graft. Repositioning to perform the vascular anastomosis. The radial artery is connected to the facial artery and a vein from the graft to the facial vein and another vein to a branch of the facial vein. Good graft perfusion at the end. Insertion of 2 Redon drains, one on the left, one on the right and two-layer wound closure on both sides. The patient is ventilated and admitted to the intensive care unit. Please continue antibiotic treatment for 24 hours postoperatively, then X-ray emesis on the 10th postoperative day and diet build-up if no fistula is present. Presentation of the patient for planning of adjuvant therapy after receipt of the histology.  