Start with PEG insertion. Entering with the esophagogastroscope. Pre-viewing into the stomach. Inconspicuous conditions on all sides. Perform the PEG insertion with good diaphanoscopy using the thread pull-through method. This is successful without any problems. Entry with the small bore tube and inspection of the hypopharynx and larynx. In the laryngeal region, a whitish deposit can be seen on the anterior third of the left vocal fold, which extends to the anterior commissure. Advance the microscope and remove this deposit while protecting the vocal folds. Microlaryngoscopically, the deposit looks like a leukoplakia. There is no indication of a polyp. Then insertion of the retractor and inspection of the tonsil region. On the right side, a crater-shaped change can be seen at the lower pole of the tonsil. The tonsil itself is also rough. Start of tumor tonsillectomy with incision of the mucosa and exposure of the upper pole. Removal of the tonsil, taking some of the musculature from the tonsil bed and taking part of the base of the tongue with it. This guarantees a sufficient safety margin. The lateral border to the neck is still intact. The tonsil is suture-marked to the frozen section. Unfortunately, the previously biopsied squamous cell carcinoma can no longer be found in the frozen section, but the margins are definitely clear, i.e. definitely an R0 situation. After consultation with the pathology department, the squamous cell carcinoma is to be looked for more precisely in the final histology. Neck dissection performed in the meantime. Transverse skin incision for this. Separation of the platysma. Formation of a platysma flap. Then expose the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland. Then free preparation of the vein. Level II shows a very large metastasis, Level II b shows several smaller ones and Level III and IV also show enlarged, coarse lymph nodes. Removal of the neck specimen en bloc while sparing the plexus branches. The large metastasis in level II can be easily detached from the internal jugular vein, but its tip extends very far towards the border of the oropharynx, creating a very small, 0.5 x 0.5 cm fistula to the oropharynx. This fistula is sutured over several times and the stylohyoid muscle and the posterior belly of the digaster are sutured over it for safety. A tracheotomy is then performed. For this, a skin incision is made below the cricoid cartilage. Exposure of the musculature. Entering the linea alba. Pushing the muscles aside. Exposure of the thyroid isthmus. Dissection of the thyroid isthmus. Exposure of the anterior wall of the trachea. Insertion between the 2nd and 3rd tracheal cartilage. Creation of a visor tracheotomy. Insertion of an 8-bore tracheal cannula. Suturing of the 8 mm tracheostomy tube. Then re-inspection of the oropharynx. The wound area is very large, so that the tracheostomy is definitely justified. Stitching over tissue in the potential fistula area. The operation was completed without complications. No oral food for 5 days please. If there are signs of fistula, open the neck. Insertion of a flap and irrigation so that the saliva can drain and then wait, as the fistula is really very small.