Transfer of the patient to the operating theater and positioning of the patient. Introductory consultation with the anesthesia department. Carrying out the team time-out. Sterile ablation and draping. Start of enoral tumor resection: insertion of a McIvor spatula. There is an ulcerous-appearing mass on the anterior palatal arch on the left side with a diameter of approx. 2.5 cm. Boundaries can be defined directly. The central ulcer is approx. 1 cm in diameter and hard on palpation. The tumor is carefully and successively removed with the ultrasonic knife under palpatory and inspector control. Both the uvula and the posterior palatal arch can be preserved. The tonsil lobe with the lower part of the tonsil is also preserved. The tumor is placed in the muscles of the palatal arch in such a way that sufficient closure is still possible and regurgitation should be avoided. Marking of the specimen after successive hemostasis. The specimen goes to the frozen section. This is R0-resected on the specimen. The penetration depth of the tumor is 3 mm. Laterally, the tumor is resected over 1 cm, basally 3 mm. As a further resection in depth would result in a large defect with subsequent flap coverage and the patient has a history of internal diseases, it is decided to leave the distance of 3 mm in depth for R0 resection. Repositioning and performing the neck dissection on the left side: skin incision and dissection through the subcutaneous fatty tissue. Splitting of the platysma and exposure of the anterior border of the sternocleidomastoid muscle. Dissection along the omohyoid muscle and finding the submandibular gland. Pulling up the submandibular glanula and exposing the posterior digastric venter. Trace it in the direction of level II b. Several metastasis-related masses can be seen here, including an approx. 4 cm mass above the accessorius nerve. This can be carefully pushed away from the accessorius nerve as well as from the internal jugular vein and the facial vein. The accessory nerve and the hypoglossal nerve can be spared. Further free preparation of the internal jugular vein and successive removal of the lateral neck preparation while sparing the brachial plexus. Successive removal of the medial neck preparation. The cervical nerve and hypoglossal nerve are exposed and preserved. The vagus nerve is also identified and can be preserved. A metastasis is palpated above the submandibular gland at level I b. This was also visualized sonographically. For this reason, successive removal of the submandibular gland on the left side. Ligation of the excretory duct. The lingual nerve with its loop was identified and spared. Successive removal of level I b. For this purpose, the marginal ramus of the facial nerve above the facial vein is first exposed and followed. A total of 6 small branches can be exposed. Ligation and removal of the facial vein and folding it upwards. Successive removal of region I a and I b so that the mandible is subsequently exposed and can be seen. Also removal of level I a. Successive hemostasis. Insertion of a Redon drain and two-layer wound closure. Neck dissection on the right: The incision is made in a curved line at the front edge of the sternocleidomastoid muscle. Use the 15 mm scalpel to sharply cut through the skin and subcutaneous tissue and platysma. Dissection of the subplatysmal flap. Dissection of the anterior margin of the sternocleidomastoid muscle. Dissection of the omohyoid muscle. Exposure of the submandibular gland, the accessorius nerve and the posterior belly of the digaster. Now the anterior neck preparation is also removed at the jugulofacial angle and medial to the cervical vascular sheath. The hypoglossal nerve is exposed and spared as well as the external and internal carotid arteries. The lateral preparation is now resected, starting with level II b to V b on the right side. There is an anastomosis between the accessorius nerve and the deep cervical plexus on the right side. No chyle fistula, no injury to the surrounding structures. Dissection of the internal jugular vein leads to a small tear in the vein, which is treated with 6-0 Vascufil. The submandibular gland to the right of the gland is then dissected out after the facial vein has been cut, ligated and folded up in order to protect the oral branch of the facial nerve. The gland is dissected and the mylohyoid muscle is exposed. Exposure of the lingual nerve. The duct is severed and ligated. Also the facial artery. Removal of the gland and complete evacuation of levels I b and I a. Punctual hemostasis. Insertion of a 10-gauge Redon drain and two-layer wound closure using 4-0 Vicryl and 5-0 Ethilon.