First, pharyngoscopy and laryngoscopy again. The tumor is found as described. This is followed by flexible esophagoscopy and, after the diaphanoscopy has been performed, a 15 mm abdominal wall probe is inserted in a typical manner without complications. Fixation of an abdominal wall in a typical manner. Then transoral resection. Tumor is incised on all sides with a safety margin of 0.5 to 1 cm and excised with relatively flat growth, especially in the palatal arch area, so that the underlying musculature is largely preserved. Resection via the alveolar ridge, preserving tissue on the bone. Resection goes over the glosso-alveolar groove down to the base of the tongue. In the area of the oropharyngeal side wall, removal of the tonsil and the outermost parts of the posterior palatal arch. Resection up to the beginning of the posterior pharyngeal wall. Resection also including the most lateral parts of the base of the tongue. Suture is thread-marked for histology. Preparation basally in healthy tissue, also laterally. Infiltrates still in situ in the area of the posterior pharyngeal wall and the beginning of the posterior palatal arch. No infiltrates caudally. ............................. not cranially. The additional margin sample inserted laterally over the alveolar ridge and the glosso-tonsillar groove was healthy. This is followed by a resection approx. 1 cm wide, which extends from the middle area of the posterior palatal arch over the beginning of the posterior wall of the pharynx to the entrance of the hypopharynx. This extends cranially and caudally with a suture mark and remote from the tumor to the frozen section. Here in the middle area still in situ infiltrates, cranially and completely caudally free. Therefore, another resection from the same area, again at least 1 cm thick, which extends to the hypopharyngeal entrance. Now in the cranial and middle area still at least medium grade dysplasia, possibly already transition to higher grade dysplasia, in the caudal area now in situ. Therefore overall suspected field carcinomatization. A strip of mucosa is again removed from the mid to caudal area extending to the hypopharyngeal entrance. This is again thread-marked, but this time for final histology. Careful hemostasis. Termination of the procedure at this point. Overall, field carcinomatization. Now transfer to neck dissection: First neck dissection on the right: skin incision in typical manner. Exposure of the sternocleidomastoid muscle. Depiction of the omohyoid muscle, depiction of the digastric muscle. Exposure of the cervical vascular sheath, internal jugular vein, internal carotid artery, external carotid artery, facial vein, superior thyroid artery. Exposure of vagus nerve, accessorius nerve, hypoglossal nerve. Successive removal of the lateral neck preparation while exposing and preserving the branches of the cervical plexus. Subsequent removal of the anterior neck preparation. The overall result is a level II-V removal. Clearly suspicious lymph nodes, at least 1-2, particularly in the Level II cranial region, followed by neck dissection on the left side. This is done in the same way as on the right side. The result is a level II-IV evacuation. Here too, at least clinically suspicious lymph nodes on the cranial side. Subsequently, careful hemostasis, irrigation of the wound area with H202 and Ringer's solution. Wound closure in layers and insertion of a Redon drain in each side of the neck. Then, in the case of an extensive defect, enoral decision to perform a tracheotomy in the sense of a protective tracheostomy. Small Kocher collar incision. Dissection through the subcutaneous tissue to the infrahyoid musculature. Splitting of these in the area of the.............................. Exposure of the thyroid isthmus. Undercutting this. Clamping, severing and supplying by means of puncture ligatures. Subsequent insertion into the 2nd/3rd intercartilaginous space. Creation of a wide pedicled Björk flap. This is successively epithelized in the typical manner. Subsequently insertion of an 8 mm tracheal cannula. Check again enorally. No signs of bleeding. Completion of the procedure without complications. Overall cT2-3 oropharyngeal carcinoma. Due to the extensive and discontinuous growth, suspected field cancerization. Last resection sent in for final margin sample. Overall indication for radiotherapy in the pharyngeal region, possibly radiochemotherapy depending on the lymph node findings. The patient is admitted to the intensive care unit for postoperative monitoring. Please continue antibiotics for 2-3 days. Nutrition for at least 1 week via the inserted PEG tube. Possibly postoperative swallowing training in the case of extensive mucosal defects, also in the posterior wall area.