First, a pharyngo/laryngoscopy was performed. The exophytic tumor described above can be seen mainly in the area of the left fold, dorsal free ary, the tumor moves anteriorly to the laryngeal epglottis and from here circumscribed to the left fold. The vocal fold level itself is free. Growth just in front of the anterior commissure. If the tumor can be easily adjusted and palpated and is easy to move, laser resection is indicated. This is now performed by <CLINICIAN_NAME>. The tumor is now successively excised from cranial to caudal. Beginning in the area of the laryngeal epiglottis, removal of the caudal epiglottis with removal of circumscribed pre-epiglottic fat. Resection of the tumor in several fragments to obtain an overview. Resection of the laryngeal part of the epiglottis. Now resection of the right pocket fold partially followed by resection of the complete left pocket fold, resection anterior to just above the anterior commissure. Macroscopic resection of the tumor clearly within the healthy tissue, safe conditions on all sides in depth during laser resection. Representative samples are now taken in the area of the supraglottis, the anterior commissure and the epiglottis. These are assessed as tumor-free in the frozen section diagnostics. Finally, dry wound conditions. Now turn to neck dissection on both sides: start with the right side. Injection of xylocaine with added adrenaline. Skin incision on the anterior edge of the sternocleidomastoid muscle. Cut through the skin and subcutaneous tissue. Exposure and transection of the platysma. Exposure and preservation of the external jugular vein and auricular nerve. Dissection of the transversus colli nerve. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the facial vein. Preservation of the facial vein and visualization of the digastric muscle. Release of the anterior neck preparation while sparing the superior thyroid artery, the cervical artery and the hypoglossal nerve. Free preparation of the internal jugular vein. Several lymph nodes measuring up to 1.5 cm, but not macroscopically suspicious, are visible in the area of the jugulo-facial angle. Exposure of the accessorius nerve. Clearing of the accessorius triangle and level V with careful protection of the cervical and caudal plexus without evidence of lymph leakage. Final wound inspection. Wound irrigation with Ringer's solution and turning to the opposite side. Same procedure here in principle. Injection of xylocaine with added adrenaline. Incision at the anterior edge of the sternocleidomastoid muscle. Cutting through the skin and subcutaneous tissue. Exposure and transection of the platysma. Creation of a platysma flap. Exposure and transection of the platysma. Creation of a platysmal flap. Exposure of the auricularis magnus nerve. An external jugular vein is not pronounced here. Exposure of the sternocleidomastoid muscle. A coarse mass measuring approx. 4 x 3 cm can now be easily palpated in levels II to III, which is still relatively easy to move, therefore the standard procedure continues. Dissection of the sternocleidomastoid muscle. Exclusion of an infiltration. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the digasatric muscle. Visualization of the facial vein, which runs directly towards the metastasis, which is located cranial to the jugulofacial angle. Therefore, the facial vein is removed. Clearing out the anterior neck preparation while exposing and protecting the superior artery. The cervical artery moves directly towards the metastasis and is taken along. Exposure of the accessorius nerve. Subsequent free preparation of the internal jugular vein. Successive detachment from the metastasis. Exposure and dissection of the common carotid artery. The metastasis is directly overlying here, but is still separated from it by a broad layer of connective tissue. The metastasis extends as far as the hypoglossal nerve, but certainly does not infiltrate it. After free preparation of the internal jugular vein from the perivascular tissue, the metastasis can also be easily separated here. Overall, no evidence of perinodal growth, well encapsulated mass, furthermore several lymph nodes measuring up to approx. 2 cm in level II and III that are not necessarily suspicious. After complete visualization of the accessorius nerve, evacuation of the accessorius triangle and evacuation of level V with careful protection of the plexus branches and final check for lymph leakage. Subsequently dry conditions. Now a new discussion of the findings with <CLINICIAN_NAME>. Plastic tracheostomy is now recommended, but no further measures are taken. Therefore, after wound irrigation of the left side, final wound inspection of both sides of the neck, insertion of a 10-gauge Redon drainage tube and careful two-layer wound closure. The tracheotomy was then performed. To do this, make a horizontal skin incision below the cricoid cartilage and cut through the skin and subcutaneous tissue. Exposure of the infrahyoid musculature, ligation of the anterior right jugular vein, exposure of the cricoid cartilage, exposure of the anterior surface of the trachea, the thyroid isthmus is relatively weak here and is coagulated in a bipolar fashion. Further visualization of the anterior surface of the trachea. Entry between the 2nd and 3rd tracheal ring. Creation of a broad-based pedicled Björk flap, smoothing of the tracheostoma edges with the conchotome and subsequent suturing of the tracheostoma and subsequent problem-free reintubation on an 8 mm tracheoflex cannula. Finally, enoral wound inspection with the Kleinsasser tube. Here the wound conditions were clear with moderate glottic edema. Dry conditions on all sides, so the procedure was ended at this point. Conclusion: This was a cT2 cN2a G2 supraglottic laryngeal carcinoma on the left, which was resected intraoperatively R0 in conjunction with the resection and the representative marginal samples. Due to the clear lymph node metastasis, adjuvant therapy is certainly indicated postoperatively. Postoperative abstinence from food for at least 3 days, after which the patient can be given a liquid diet depending on swallowing function and, depending on the development of swallowing function, can be decannulated during the inpatient stay. The patient received intraoperative single-shot antibiotics with Unacid 3 g and a single dose of 250 mg SDH.