Bronchoscopic intubation by anesthesia colleagues. This proved to be extremely difficult as the supraglottic tumor masses almost completely obstructed the pharyngeal and laryngeal entrance. After laborious attempts, a tube was finally placed. Performing pharyngoscopy and laryngoscopy with the small bore tube. The tumor described above can be seen in the area of the epiglottis. The epiglottis is completely consumed, the tumor extends over both aryepiglottic folds to the arytenoid cartilage, on the right side the arytenoid cartilage is completely infiltrated, on the left side it extends to the arytenoid cartilage. The pocket folds are infiltrated on both sides and the lateral edge of the vocal fold is also infiltrated on the right side. Then injection of Ultracaine and sterile washing and covering. Creation of an apron flap in the usual manner. Start with neck dissection on the right side. This shows several large metastases in the area of the sternocleidomastoid muscle and the cervical vascular sheath. First visualization of the submandibular gland and the omohyoid muscle. Visualization of the digaster and hypoglossus. The metastases cannot be detached from the sternocleidomastoid muscle, nor from the internal jugular vein. The common carotid artery is displaced far to the dorsolateral side. Now switch to the left side in order to obtain the internal jugular vein. Expose the sternocleidomastoid muscle, the submandibular gland and the omohyoid muscle. Then expose the cervical vascular sheath. Dissection of the internal jugular vein and detachment of the neck preparation from the cervical vascular sheath. Several large metastases here too. Here, the larynx is first dissected by detaching the thyroid gland, the superior thyroid artery and severing the upper laryngeal bundle. Detachment of the oblique laryngeal muscles. Change to the opposite side. Continuation of the neck dissection by separating the sternocleidomastoid muscle at the lower attachment. It can be seen that a large metastatic conglomerate extends below the clavicle. Careful dissection here. Separation of the internal jugular vein and high dissection of the conglomerate, detaching it from the common carotid artery and later from the bulb. The sternocleidomastoid muscle is also severed in the upper part. The accessorius nerve can be preserved here. Separation of the internal jugular vein and removal of the large metastatic conglomerate. Then removal of the remaining fatty tissue from level II b, sparing the plexus branches. Level VI was integrated into the metastatic conglomerate. Now release of the larynx. Detachment of the oblique laryngeal muscles. Separation of the laryngeal bundle. Detachment of the thyroid gland and the cervical vascular sheath at the larynx. Detachment of the hyoid bone at the base of the tongue. Integration of the hyoid bone into the laryngeal preparation. Now perform the tracheotomy. For this, insertion between the 1st and 2nd tracheal cartilage and reintubation onto a laryngectomy tube. Now release the piriform sinus, first on the right side, then on the left side, in the usual manner. This must be done very carefully so as not to ........ into the tumor. Then enter the pharynx from the left side. This must be done relatively high up, as the tumor is a supraglottic laryngeal carcinoma with complete infiltration or consumption of the epiglottis. This is then carefully dislocated upwards. Then incision of the mucosa along the epiglottis borders up to the postcricoid region on the left side, then the same on the right side, while sparing the piriform sinus. Now place the larynx below the cricoid cartilage. Suture marking. Taking marginal samples. The marginal sample of the lateral pharyngeal wall still shows carcinoma in situ in the center. A resection was performed and a final margin sample was taken. Final complete R0 situation. In the meantime, a Provox prosthesis of size 8.0 was placed in the usual manner using the pull-through method. Then, in the meantime, completion of the neck dissection on the left side by <CLINICIAN_NAME>. For this purpose, the neck preparation was removed while sparing the plexus branches and the accessorius nerve at level II a to V a. The internal jugular vein and superior thyroid artery were preserved. Now start with the pharyngeal suture, initially in the base of the tongue with creation of a small T, but the mucosa is very dilapidated and begins to tear towards the oropharynx on both sides. Intraoperative demonstration to <CLINICIAN_NAME>. He recommends reopening the previously sutured pharyngeal suture and starting again. This is also the same as the first time with the same result that the mucosa tears again and again due to maceration. Finally, the mucosa in the area of the oropharynx must be sutured transorally and then the pharyngeal suture must be sutured in the usual manner, first in the area of the base of the tongue and then in the area of the mucosa in two layers with single button sutures. Finally, readaptation of the pharyngeal muscles so that no laryngeal stenosis occurs. Then incision of the tracheostoma and creation of a mucocutaneous anastomosis and reintubation to a 10 mm tracheostomy tube. Two 10-gauge Redon drains were inserted beforehand and the procedure was completed with a two-layer wound closure. Please check the wound daily and open the throat extensively if a fistula occurs. The risk of fistula is greatly increased in this patient due to the difficult pharyngeal-mucosal conditions. A nasogastric tube is not inserted so that no additional foreign material is placed in the affected pharyngeal mucosa. X-ray gruel swallow on the 12th postoperative day. Continuation of antibiotics for 1 week.