At the beginning of the procedure, laryngoscopic adjustment of the glottic plane after induction of intubation anesthesia. This is extremely difficult with poor mouth opening and poor hyperextensibility of the neck. With Cormack III, an inspection of the upper parts of the trachea with 0° optics is possible. The glottis is non-irritating and unremarkable. The patient is then intubated by the surgeon with great effort. Overall difficult airway. The esophagus is then inspected as part of flexible esophagogastroscopy. It is extremely difficult to enter the upper esophageal sphincter in the case of esophageal cancer and radiation. Finally, the flexible instrument can be advanced with difficulty up to 20 cm from the tooth row. This reveals a web-like stenosis of the esophagus that cannot be overcome by the flexible endoscope. In this case, if the patient has undergone pre-treatment and has a malignant tumor, no forced attempt is made, so that esophagoscopy is only performed up to 20 cm from the tooth row and the distal parts of the esophagus can then no longer be inspected. Removal of the esophagoscope. Now reposition the patient and inspect the oral cavity and oropharynx as well as the hypopharyngeal and laryngeal skeleton. In the hypopharyngeal and laryngeal region, the mucosal conditions are unremarkable. In the area of the oropharynx, an exophytic mass can be seen in the area of the glossotonsillar groove. The tongue is clearly fixed and the posterior part is clearly scarred and hardened. The tongue is then sutured and an oral retractor inserted. If the findings are histologically confirmed externally, resection begins from the anterior margin with a safety margin of around 5 mm. The resection extends into the body of the tongue. It can be seen here that the tumor has clearly grown submucosally into the body of the tongue and into the base of the tongue. Two large tumor necrosis cavities can be seen here. The external CT is superimposed by massive artifacts, so that this area could not be evaluated. The overall extent of the tumor thus proved to be much larger than estimated preoperatively. The tumor is then incised with an electric needle. Care is taken to maintain a safety margin of around 5 mm. After the body of the tongue can be mobilized better with increasing resection, it becomes apparent that the tumour is spreading to the tonsil lobe. Therefore, resection up to the alveolar ridge at the back of the posterior molars up to the tonsillar lobe. The resection extends from here to the anterior and posterior palatal arch. The preparation is then sent for histological examination. Subsequently, marginal samples are taken from all representative areas of deposition. Subsequent subtle hemostasis. The tumor is macroscopically and palpatorily distant from the healthy tissue. If the wound is dry, infiltrate bupivacaine into the body of the tongue. As the wound area is now clearly extensive and the patient has a restricted airway and therefore a significantly impaired airway, <CLINICIAN_NAME> is consulted and an intraoperative discussion regarding tracheostomy is held. A consensus was reached to perform a small tracheostomy in the sense of a protective tracheostomy. Wound check again. Removal of the mouth block and loosening of the tongue retaining suture. Then injection of local anesthetic with adrenaline in front of the trachea. Transverse skin incision and layered preparation in depth. Separation of the platysma. Separation of the prelaryngeal muscles. Layered dissection in depth. Exposure of the thyroid isthmus. This is undermined and stitched around on both sides after it has been severed. Exposure of the anterior surface of the trachea. Now incise the trachea between the second and third cartilage clasp. Preparation of a Björk flap. Circular suturing of the tracheostoma. Then reintubation to an 8 mm tracheal cannula with a large tracheal lumen. This was successful without any problems. Then dressing and fixation of the cannula. Final enoral check. Dry wound conditions. The patient is transferred to the in-house intensive care unit for safety and monitoring. This concludes the procedure. Postoperatively, the patient's swallowing function must now be monitored. The patient is not yet neck-dissected on the left side, so that depending on the functional result, treatment and defect coverage using a radial flap is still possible here.