Induction of anesthesia by the anesthetist, then insertion of the mouth guard and inspection of the oropharynx. An approx. 2 cm submucosal nodular change can be seen on the left oropharyngeal side wall paramedian, this is cut around with the scalpel with a safety margin of at least 0.5 cm, then further dissection with pointed scissors and bipolar forceps. Start suture marking still in situ, then successive dissection of the mass macroscopically in healthy tissue. The specimen is thread-marked and sent for frozen section. The pathologist cannot detect any invasive carcinoma or carcinoma in situ. Isolated, moderate dysplasia can be seen in the far lateral area. No resection is performed. During the frozen section break, start with the neck dissection on the right side. Skin incision in the usual manner. Exposure of the sternocleidomastoid muscle, exposure of the omohyoid muscle, exposure of the submandibular gland and the accessorius nerve. Then free preparation of the internal jugular vein, release of the neck preparation II-V while sparing the plexus branches. Level V is also cleared out because slightly enlarged lymph nodes are visible here, which were also removed for this purpose. All structures can be spared except the external jugular vein. Then turn to the opposite side. Here also the usual skin incision along the anterior edge of the sternocleidomastoid, exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle, the submandibular gland and the cervical vascular sheath with exposure of the internal jugular vein. The external jugular vein was removed. In level II at the border to level Ib there is a large lymph node metastasis which is resected en bloc. The remaining neck level II-V was then released, sparing the plexus branches and all important nerve and vascular structures. Insertion of Redon drains and two-layer wound closure. A gastric tube is not inserted as the defect is only circumscribed. Waiting for the histology and presentation of the patient at the tumor conference to plan adjuvant therapy. Cautious diet build-up with liquid, mushy food possible.