After induction of anesthesia and intubation by the anesthesia colleagues and anesthesia preparation, re-evaluation of the primary tumor. Entry with the Kleinsasser tube. As described above, the exophytic tumor can be seen starting caudal to the right tonsillar lobe, extending laterally caudally over the lateral wall of the oropharynx and anteriorly towards the base of the tongue over the pharyngoepiglottic fold, also reaching the lateral epiglottis. In addition, the right-sided vallecula is clearly infiltrated. Palpatory superficial tumor growth, as well as tumor extension at the lateral place of the aryepiglottic fold. Overall just T2. Due to the good displaceability and lack of signs of growth per continuitatem, laser resection was confirmed. The tumor can be completely removed macroscopically with the CO2 laser at a power of 2-8 watts. Resection with caudal tonsil ligament, pharyngeal side wall, right-sided superficial removal of the base of the tongue, removal of the right vallecula and, in the case of somewhat edematous epiglottis and questionable infiltration, removal of the narrow strip of the epiglottis with cartilage. The right aryepiglottic fold must also be resected. The tumor ends in front of the entrance to the right piriform sinus. No further extension into the hypopharynx. Macroscopically complete removal in depth, safe conditions on all sides. ................ Resections in soft tissue of the neck or no evidence of exposed fatty tissue. This is followed by complete coverage of the entire tumor by means of marginal samples, which are completely tumor-free; only in the area of the lingual epiglottis are there markedly inflammatory infiltrates with no further possibility of differentiation, but the possibility of residual tumor cells, which is why a resection and a final marginal sample are performed here, which is again diagnosed as completely tumor-free in the frozen section diagnostics. Endoscopic PEG placement had already been performed previously. This was done using a gastroscope under laryngoscopic control. Easy to see through to the stomach. Excellent diaphanoscopy. Problem-free puncture of the stomach and subsequent positioning of the PEG tube using the usual suture pull-through method. The plastic tracheostomy was performed in the meantime. This involved a horizontal skin incision at the level of the cricoid cartilage, cutting through the skin and subcutaneous tissue, exposing the infrahyoid muscles, entering the linea alba, exposing the cricoid cartilage, exposing the anterior surface of the trachea. Insertion between the 1st and 2nd tracheal ring, creation of a broad-based pedicled Björk flap and insertion of the tracheostoma. Subsequently, problem-free reintubation to a size 8 low cuff cannula. After injection of xylocaine with adrenaline, functional neck dissection is now performed, initially starting with the right side. Here there is an extensive coarse mass measuring well over 10 cm in all dimensions from the caudal parotid gland to region IV with extensive infiltration towards the paravertebral musculature. Skin incision around the lobule over the mastoid, curved towards the cervical in a typical shape. Cut through skin and subcutaneous tissue. Dissection of the skin mantle, this is not infiltrated at any point, the platysma is largely left on the metastasis to leave a layer. Release of the lobule, exposure of the anterior wall of the auditory canal, exposure of the parotid capsule. Exposure of the sternocleidomastoid muscle, which is extensively infiltrated. Exposure of the omohyoid muscle. Caudal exposure of the sternocleidomastoid muscle. Exposure of the infiltrated internal jugular vein caudally. Separation of the common carotid artery and the vagus nerve. Detachment of the metastasis caudally, including up to level Vb, here at least one further highly suspicious mass measuring approx. 3 cm, otherwise several macroscopically not necessarily conspicuous lymph nodes. Resection up to the brachial plexus, but this itself remains covered. The cervical plexus is resected subtotally. The auricularis magnus nerve could be dissected away from the mass beforehand and remains intact for subsequent splinting if necessary. Exposure of the submandibular gland and the anterior digstricus muscle. Dissection shows that the submandibular gland is also infiltrated dorso-caudally. The digastric muscle is long and extensively infiltrated, with the mass extending to the mandible. This is followed by release of the submandibular gland and ligation of the facial artery. Exposure of the common carotid artery and the bulb, exposure and release of the internal carotid artery and the vagus nerve, which can remain completely intact. Also in the area of the entire common carotid artery and the internal carotid artery .............. Adeventitia. Dissection of the external carotid artery, ligation of the superior thyroid artery. The external carotid artery is infiltrated in the canal and is later removed. Exposure of the infiltrated hypoglossal nerve. This is also removed. Exposure and preservation of the lingual nerve. The mass reaches around the mandible, infiltrating it, but certainly not the periosteum. There is also no infiltration of the floor of the mouth, but large parts of the floor of the mouth muscles are involved. It can now be seen that the mass clearly extends into the parotid gland. The decision was therefore made to expose the main trunk. Exposure of the pointer. Release of the mastoid here close to the attachment. Infiltration of the digastric muscle, exposure of the main trunk, which is clearly displaced here but not infiltrated, the mass can be completely removed from the parotid gland by extubation of the caudal parotid gland with resection of only the most caudal branch of the mouth. Overall significant displacement of the facial nerve in the course of the procedure with possibly protracted recovery. Exposure and release of the mastoid, involvement of large parts of the scalene muscles. The phrenic nerve can be preserved. Removal of a muscle sheath on all sides and resection of the metastasis macroscopically in toto, even after final examination, no margin-forming areas, a small tumor cone was resected separately in the area of the floor of the mouth so that a complete in sano resection was performed. Finally, completion of level Ib, with several macroscopic nodules. After multiple careful wound inspections and wound irrigation, careful control of the pharyngeal area, where no patency to the primary tumor area could be probed or visualized, so that 2 Redondra rings were inserted and the subsequent ..............  wound closure. Carry out the neck dissection on the left side. To do this, make a house incision on the front edge of the sternocleidomastoid muscle and cut through the skin and subcutaneous tissue. Exposure and dissection of the platysma. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digasatric muscle. There are several nodules up to 2 cm in the area of the vein course and in the area of the jugulo-facial angle, but macroscopically not necessarily suspicious. Dissection of the internal jugular vein and preservation of the facial vein, the superior thyroid artery and the hypoglossal nerve. Exposure of the accessorius nerve, clearing of the accessorius triangle and completion of levels III and IV with careful protection of the cervical plexus branches. Subsequent inspection of the wound area and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Final enoral inspection and, if the wound is dry, termination of the procedure at this point. Several intraoperative discussions of the findings and case were held with <CLINICIAN_NAME>. The patient received intravenous antibiotics with Unacid 3 g, to be continued for 24 hours postoperatively. Conclusion: Transoral laser resected, intraoperative cT2 cN3 R0 oropharyngeal carcinoma on the right with extended radical neck dissection and resection of the cervical plexus of the hypoglossal nerve and the caudal parotid gland. Adjuvant radiochemotherapy appears to be absolutely necessary here. Please initially feed for 7 days via the inserted PEG tube, followed by a clinical swallowing trial. Due to the resection area of the primary tumour site and the extensive extended radical neck dissection, a protracted recovery of swallowing function is to be expected here.