Initial inspection of the primary tumor region. An exophytic, exulcerated mass is seen in the area of the posterior third of the tongue, at the transition to the base of the tongue. This extends submucosally in a nodular fashion towards the posterior floor of the mouth and palpates and inspects via the glossotonsillar groove into the left tonsil and infiltrates it caudally. Submucosally also clear infiltration of the base of the tongue and infiltration of the tongue musculature. Overall clear cT2 extension. Transorally good resectability, but due to the extension in the area of the posterior floor of the mouth, the base of the tongue and the tonsil loge, indication for defect reconstruction. Demonstration of findings and case discussion with <CLINICIAN_NAME>. Confirmation of the extent and initial resection as planned. The tumor is therefore resected, taking the posterior free edge of the tongue on the left. Removal of the posterior floor of the mouth. A slightly extended tonsillectomy is performed. Here circumscribed exposure of neck fat tissue. Resection in the area of the base of the tongue, approx. one third, here also clearly extending into the musculature. Macroscopically safe resection distances. Targeted ligation of the lingual artery, which draws directly into the tumor and finally extirpation of the tumor macroscopically in toto, which is thread-marked for frozen section diagnostics and is assessed here as resected in sano. Careful hemostasis. Insertion of a nasogastric feeding tube under laryngoscopic control. Due to the resection defect, there is now an indication for functional reconstruction of the defect. Therefore, initially only the neck dissection of the contralateral side and, due to the depth of resection, the protective tracheostomy are performed. Neck dissection of the right side is performed first. Skin incision along a horizontal cervical skin fold. Cut through skin and subcutaneous tissue. Separation and dissection of the platysma. Exposure and preservation of the external jugular vein and auricular nerve. Exposure of the sternocleidomastoid muscle, omohyoid muscle. Release of the submandibular gland, taking the capsule with it. Exposure of the digasticus muscle and facial vein. Dissection of the internal jugular vein. Removal of the anterior neck preparation with careful protection of the facial vein, the superior thyroid artery, the cervical artery and the hypoglossal nerve. Cranial exposure of the accessorius nerve. Complete dorsal exposure of the internal jugular vein, exposing the common carotid artery and the vagus nerve up to the transition towards level V a, carefully sparing the cervical plexus branches. Overall, macroscopically no suspicious nodules. Careful wound irrigation with Ringer's solution and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Now create the protective tracheostomy. This involves a horizontal, circumscribed skin incision below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Expose the infrahyoid musculature and enter the linea alba. Exposure of the cricoid cartilage and the anterior surface of the trachea. Dissection of the thyroid isthmus. Insertion between the second and third tracheal ring. Creation of a visor tracheotomy. Incision of the cranial and caudal mucocutaneous anastomosis and subsequent problem-free intubation with a size 8 low-cuff cannula and completion of the procedure without any indication of complications. Conclusion: Intraoperative R0-resected cT2 cN0 oropharyngeal carcinoma on the right with clear infiltration of the base of the tongue. Due to the defect and the expected functional deficit with secondary wound healing, defect reconstruction using a microvascular graft (ALT or radialis) should be performed together with ipsilateral neck dissection. This should be planned promptly.  