First of all, another pharyngoscopy and laryngoscopy: There is no further clinical evidence of a mass, apart from the hardening in the area of the left tonsil. However, a tonsil stone had been retrieved here during the pre-panendoscopy. However, an indurated tonsil was found, the induration also extends into the soft tissue slightly outside the left tonsil. Therefore, clear cutting outside the tonsil border cranially and also laterally as well as to the depth, entraining mucosa and also muscle tissue. Successive removal of the tonsil and attached soft tissue macroscopically clearly in healthy tissue, in the sense of an extended tonsillectomy. Resection caudally to the base of the tongue. The muscles, including the pterygoid muscles, are removed towards the depths. The posterior palatal arch can initially be completely preserved, while the anterior arch is completely resected. Muscle parts in the palatal arch area are also preserved. The specimen is marked with sutures. Separate cranial medial and cranial lateral margin specimens as soft tissue margin specimens. In the frozen section with infiltrations, which form margins in the cranial and medial areas. The two soft tissue margin samples towards the depth are healthy. Therefore, recutting of mucosal strips with attached soft tissue cranially in the entire area and medially. Tumor is marked with suture in each case remote from the tumor. No more infiltrates in the frozen section, so now R0 resection. In view of the situation, neck dissection is now also possible and indicated. Injection of a total of 10 ml Ultracaine 1% with adrenaline. Sterile draping. Skin incision including the old scar. Laborious dissection through the scar tissue. Exposure of the sternocleidomastoid muscle. Exposure of the digastric and omohyoid muscles. Exposure and preservation of the external jugular vein. Exposure and preservation of the facial vein. Exposure and preservation of the internal jugular vein and external carotid artery. Visualization and preservation of the vagus nerve. Extreme scarring anterior to the vein or artery around the facial vein and around the capsule of the submandibular gland. This is dissected free. Level II to V are then evacuated while preserving the branches of the cervical plexus. Finally, careful hemostasis. Irrigation. Wound closure with 3-0 Vicryl single button sutures and 4-0 skin sutures and insertion of a Redon drain. Subsequent enoral inspection. No bleeding. The procedure was completed without complications. Overall cT1 to 2, more likely cT2 tonsillar carcinoma on the left, R0 according to marginal samples. Neck dissection at least cN1. Please attend the interdisciplinary tumor conference after receiving the final histology. If, contrary to expectations, there is no R0 resection at one site, flap coverage must be discussed.