First insertion of the tonsil plug and inspection of the tumor region. The tonsils can be palpated on the right side. There is a hard tumor submucosally. Tumor resection by <CLINICIAN_NAME>, who first begins the resection with the electric needle right next to the uvula on the anterior palatal arch. Part of the anterior palatal arch is removed. Then transition to the lateral pharyngeal wall and dissection of the tonsil, including a small muscular cuff. The base of the tongue itself is free and does not need to be resected. A portion of the posterior palatal arch can be left. The preparation is thread-marked for the frozen section. In the area of the anterior palatal arch, a marginal sample is taken directly after the tumor resection, which is also thread-marked and sent for histology. The pathologists still found tumor cells in the basal area, so a generous resection is performed in the area of the anterior palatal arch, the lateral pharyngeal wall and the basal tonsillar lobe area. No further resection is possible here, as small areas of fat from the neck are already visible. However, the resected area is tumor-free. Then neck dissection on the left side. Skin incision in the usual manner. Exposure of the sternocleidomastoid muscle, exposure of the omohyoid muscle. Exposure of the accessory muscle, then the submandibular gland and the digastric muscle. Exposure of the cervical vascular sheath. Dissection of the internal jugular vein. Evacuation of levels II, III and IV. Intraoperatively, the decision is made to also evacuate level V, as there are some visible lymph nodes here. Neck dissection on the right side. After discussion with <CLINICIAN_NAME>, the decision was made to perform a neck dissection on the right side. However, to proceed very carefully in the area of the submandibular gland so as not to produce a fistula. Skin incision in the usual manner. Exposure of the sternocleidomastoid muscle anterior margin, exposure of the omohyoid muscle. Then explore the submandibular gland, proceeding with extreme caution so that the gland is not completely dislocated. Exposure of the digastric muscle. Very careful dissection here too. Free dissection of the internal jugular vein. Level II shows a soft, cystic mass, which initially does not look metastatic; from the macroscopic aspect it could be a cystadenolymphoma of the parotid gland or a lymphangioma, which is demonstrated intraoperatively to <CLINICIAN_NAME>. He recommends removing this mass anyway. To do this, the skin incision is widened slightly and the mass is removed completely. Then clearing out level IIa to Va while sparing the accessorius nerve and the plexus branches. Exposure of the hypoglossal nerve, which can also be preserved. Then perform a tracheotomy. Skin incision in the usual manner. Dissection down to the musculature. Push the muscles to the side in the midline. Exposure of the thyroid isthmus, which is very small and can be coagulated and transected in a bipolar fashion. Exposure of the trachea. Entering the trachea between the 1st and 2nd tracheal cartilage. Creation of a visor tracheotomy. Creation of a mucocutaneous anastomosis and insertion of a size 8 tracheal cannula. Continue antibiotics postoperatively. No oral food on the day of surgery. On the next day, please demonstrate to the surgeon; fluids can probably already be started. Otherwise, present the patient to the tumor conference.