Start with pharyngoscopy: inspection of the oral cavity, buccal mucosa and oropharynx. A spherical mass can be seen in the area of the right edge of the tongue at the transition from the edge of the tongue to the base of the tongue opposite the alveolar ridge. A causative tooth-related alteration cannot be detected, which is why this site is highly suspicious for malignancy, corresponding to the illumination in the PET-CT. The right tonsil was also conspicuous on PET-CT. Tonsillectomy started on the right side: Incision at the upper tonsil pole. Blunt, partly sharp release of the tonsil from its bed. Repeated bipolar coagulation underneath. At the end here wound surfaces free of bleeding after extirpation of the tonsil at the lower pole, after removal with the bipolar in toto. Then insertion of the reinforced retractor. Insertion of a Mersilene into the tip of the tongue, fluxing out and then consecutively, with bipolar coagulation and scissors, 1 cm in the healthy tissue, removal of the suspected carcinoma. This is then confirmed and identified as a carcinoma by telephone frozen section. Resection status in the frozen section R0. Low to moderate grade dysplasia is diagnosed in the tonsil, there is no carcinoma growth. Now advancement of the size C small bore tube into the hypopharynx/larynx. Inconspicuous conditions everywhere. Now insertion of the flexible esophagogastroscope, advancement into the esophagus. A fibrin-covered, superficial erosion can be seen 35 cm aborally, which most likely corresponds to an inflammatory change. Please perform a control gastroscopy in internal medicine! Pre-mirroring into the stomach. After skin disinfection and infiltration anesthesia, a percutaneous endoscopic gastrostomy tube 9 Charričre can now be placed. This is done under strict diaphanoscopic control and works well. Fix the holding plate with adequate pressure. Sterile dressing. Now repositioning for parotid surgery and neck dissection. Application of neuromonitoring, skin disinfection, infiltration anesthesia. Opening of the old skin scar in the area of the parotid ligament. Dissection of a ventral pedicled flap after spindle-shaped excision of the previously made skin incision. The macroscopic tumor described above can be seen here. First expose the anterior margin of the sternocleidomastoid. Dissect cranially up to the lobule. Careful release of the laterocaudal part of the gland. Then dissect the cartilaginous auditory canal in depth. Exposure of the pointer. Then expose the facial nerve trunk. This is now followed in its cervicofacial portion into the periphery. The cervical branch cannot be preserved, but the marginal ramus can. Then complete detachment of the caudal parotid pole in toto. The cranial resection margins are macroscopically unremarkable. The complete parotid pole is then removed, taking the digastric muscle with it in toto. Identification of the hypoglossal nerve and the accessorius nerve. However, it can be seen that the hypoglossal nerve runs through the metastasis, as well as the vagus nerve in its cranial part through the tumor and the accessorius. First widening of the skin incision. Exposure of the anterior margin of the sternocleidomastoid at the lower part. Exposure of the small venous angle. Exposure of the omohyoid and dissection along the digastric muscle ventrally. The metastasis is located in level V or II. After creating clear conditions, demonstration of the findings on <CLINICIAN_NAME>. The infiltrated auditory nerves cannot be preserved, nor can the internal jugular vein. Double ligation and removal of the internal jugular vein, removal of the vagus nerve, the hypoglossal nerve and the accessory nerve. Complete removal of the metastasis in toto. Parts of the sternocleidomastoid muscle are also removed in the accessorius triangle. In this way it is possible to remove the metastasis in toto while leaving microscopically inconspicuous tissue parts. Dissection of the vessel.......... upwards. Exposure of the internal carotid artery, external carotid artery and internal jugular artery far below the omohyoid muscle. At the base of the skull before removal of the internal jugular vein as part of the tumor conglomerate ligation and repositioning. This results in a neck dissection from level I b to V. At the end, ensure hemorrhage-free conditions. Stimulation of the facial nerve and the dissected branches with 0.5 mA. Irrigation with Ringer's solution. Placement of a Redon drain and two-layer wound closure and pressure dressing. Conclusion: Tongue margin carcinoma cT1 cN2b. Modified radical neck dissection with resection of the vagus nerve, hypoglossus, accessorius. Please perform postoperative gastroscopy as described above. Wound irrigation with Betaisadona solution for 1 week. Tonsillectomy diet from the 3rd to 5th day. Ensure adequate analgesia. Cervical suture removal on the 7th postoperative day.