After appropriate preparation, the septum and paranasal sinus surgery is performed first. After shortening the vibrissae, hemitransfixion incision on the right and creation of the upper and lower tunnel according to Cottle on the left side. Vertical chondrotomy. Creation of the upper and lower tunnel on the right side. This allows the cartilaginous bony spur, which has deviated markedly to the right, to be adequately exposed and resected. This results in a slit-shaped mucus defect. The middle nasal passage is then exposed by carefully medializing the middle turbinate without fracturing it. Removal of the uncinate process. Creation of a large maxillary sinus window, from which inflammatory swollen mucosa emerges from the ostium. Subsequent clearing of the maxillary sinus with macroscopically typical aspects of fungal sinusitis. Subsequently, extensive rinsing of the maxillary sinus after maximum expansion of the supraturbinal maxillary sinus window. Subsequently, replantation of crushed pieces of cartilage and bone between the dorsal septal mucosal sheets. Fixation of the anterior septal pillar to the anterior nasal spine using sutures. Suturing of the right hemitransfixion incision. Placement and transseptal fixation of septal foils on both sides. Nasal tamponade on both sides, which is mutually fixed in front of the columella. The tracheostomy is then performed. After a skin incision about 2 QF above the jugulum, sharp transection of the cutis, subcutis and subcutaneous fatty tissue with exposure of the linea alba. Dissect the straight neck muscles along the linea alba and expose the thyroid isthmus. Passing under the lamina pretrachealis, pinching off, setting down and repositioning on both sides. This clearly shows the 4 upper tracheal clips. Opening of the trachea between the 2nd and 3rd tracheal clasp and completion of the mucocutaneous anastomosis. Easy reintubation of the patient after tube removal. PEG placement (<CLINICIAN_NAME>, <CLINICIAN_NAME>). Entry with the gastroesophagoscope under air insufflation. Pre-insufflation into the stomach. After spontaneous diaphanoscopy, insertion of a PEG in the typical manner using the thread pull-through method. Prior to this, perioperative administration of Unacid 3 g. Subsequently, transition to transoral tumor resection. After insertion of the tonsillar blocker with the mouth opening clearly restricted, the entire right tonsil, especially in the caudal area, is resected successively with the ultrasonic knife. The resection begins at the upper tonsil pole parauvularly and encompasses the entire tonsil lobe. The resection is performed caudally along the ascending mandibular branch with a remaining gingiva of about 2-3 mm opposite the molars. Here it becomes clear that the tumor cannot be safely removed from above, especially in the caudal region towards the base of the tongue and the glossotonsillar groove. Therefore, the neck dissection is first performed on the right side. Here, the vascular nerve sheath is exposed after a skin incision. After exposing and dissecting the digastric muscle, the large cystic metastasis is developed from medial to lateral together with the neck dissection specimen. All non-lymphatic structures are spared. After exposing and skeletonizing the accessorius nerve, regions II to V are then completely removed. The submandibular gland and region I are then removed. Dissection of the digastric muscle. This already reveals the defect enorally. The lingual nerve is exposed and can be spared until the end, as can the hypoglossal nerve. After slight widening, the cranially already resected tumor can be moved outwards and the caudal area in the area of the glossotonsillar groove or base of the tongue can finally be removed in toto under visualization. The frozen section histological examination of the specimen shows tumor-free margins on all sides. The minimum distance to the depth is 0.3 cm. For this reason, the remaining tissue on the external carotid artery in the area of the deep margin is also removed retrospectively so that the vascular nerve sheath is exposed cranially and all tissue is removed. This results in a defect measuring approximately 9 x 5 cm. Removal of the radial elevation of the radial forearm flap on the left (<CLINICIAN_NAME>, <CLINICIAN_NAME>, PJ): Palpatory identification of the distal radial artery, marking of the flap borders 9.5 x 7.5 cm on the distal forearm proximal to the flexor retinaculum with S-shaped course on the incision proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the stenosis confluence in the cubital fossa, identification of the cephalic vein. Dissection of the vein distally with integration into the radial flap graft edge. Identification of the external ramus of the radial nerve and elevation of the radial portion while leaving the peritendinous tissue of the brachioradialis muscle. Subsequent ulnar incision down to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendinous tissue on the flexor tendons and to spare the ulnar artery. Identification of the distal radial artery and probatory clamping with a vascular clamp after 5 minutes under good pulse oximetry measured oxygen saturation, measured on the thumb, the vessels are removed with subsequent lateral thread ligation. Successive detachment of the flap pedicle from the pronator quadratus and flexor pollicis longus muscles and bipolar coagulation of the outgoing perforators as well as supply with a vessel clip into the cubital fossa. Exposure and protection of the radial nerve in the median side of the brachioradialis muscle. Exposure of the brachial artery and the ulnar artery. There is no V. mediana cubiti, only a V. cephalica. First, the radial artery and the 2 accompanying veins are dissected so that they can be connected later and the cephalic vein is cut very far proximally for connection to the jugular vein, later. After exposing the ulnar, brachial and radial arteries, the radial artery is removed while sparing all other vessels. Punctual hemostasis in the area of the wound bed with bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm and the graft bed with split skin from the right thigh in the usual manner. The split skin was previously divided three times and lifted. Application of a wound dressing and forearm splint. Completion without complications. Continuation of the operation on the neck with neck dissection of regions II to V on the left side. After insertion of a Redon suction drain, two-layer wound closure. The lifted radialis flap is then sutured into the defect, initially from the transcervical and in the cranial region from the transoval side, and the pedicle is passed outwards. The arterial anastomosis is made to the facial artery, while the venous anastomoses are connected to the internal jugular vein with 2 veins of the flap in an end-to-side manner. After hemostasis, placement of a drain and a Redon suction drain. Two-layer wound closure. Re-intubation of the patient onto an 8-gauge tracheostomy tube. Stable wound dressing. End of the operation. Conclusion: Initially plastic septal correction for septal deviation and ethmoid bone and maxillary sinus surgery on the right side for fungal sinusitis of the right maxillary sinus. Subsequently, combined transoral-transcervical tumor resection of a tonsillar carcinoma on the right side with selective neck dissection of regions I to V on the right and II to V on the left side. Defect coverage with a microvascular anastomosed radial artery flap graft from the left forearm. Arterial anastomosis to the facial artery, venous anastomosis of 2 veins end-to-side to the internal jugular vein on the right side, creation of a plastic tracheostoma, PEG creation, defect coverage on the left forearm with split skin from the right thigh.