First, the oral cavity and oropharynx are opened up: the tumor is revealed, covering the soft palate and both tonsil regions in the area of the upper third on both sides. Now the tumor is successively excised in toto with the electric knife, starting from the top, with attached tonsils. Subsequently, marginal samples are taken from the area of the margin, in the area of the soft palate cranially, laterally, left and right and from the area of the left tubal region, as a hyperdense mass was found there on CT. All marginal samples are free of carcinoma in the frozen section diagnosis. Now perform the neck dissection on the left: Incision in the area of the front edge of the sternocleidomastoid muscle, caudal exposure of the jugular vein, the common carotid artery and the vagus nerve. The lateral neck dissection preparation is now developed from caudal to cranial for 2, 3 cm. The digaster muscle and the hypoglossal nerve are now explored cranially. A large metastasis in the area of the venous angle on the left can be dissected with difficulty from the cervical vascular sheath and cranially. This mass has impacted the accessorius nerve so that it has to be partially resected. Now explore the carotid bifurcation medially. Expose the superior thyroid artery, the lingual artery and the ascending pharyngeal artery. Neck dissection on the opposite side: incision in the area of the front edge of the sternocleidomastoid muscle. Caudal exposure of the common carotid artery, the jugular vein and the vagus nerve. The lateral neck dissection specimen is now dissected cranially for approx. 2 to 3 cm. Cranially expose the digaster muscle, the hypoglossal nerve and the accessorius nerve. The lateral neck dissection specimen is now removed in toto from cranial to caudal while protecting the cervical nerve plexi as much as possible. Medial view of the carotid bifurcation. Exposure of the superior thyroid. Now tracheotomy: Transverse skin incision 2 transverse fingers below the thyroid cartilage. Cut through the subcutaneous tissue. Exposure of the thyroid isthmus, clamping of the same, left and right transection of the same. The trachea is now incised between the 2nd and 3rd tracheal cartilage, a Björk flap is formed and the trachea is sutured to the skin in a stable manner. Now lift the radial flap. For this purpose, a corresponding skin area is painted on in the area of the palmar / forearm surface. The radial flap is now developed from the ulna in the form of a fasciocutaneous flap. The radial artery and radial nerve are now shown laterally. The radial artery is clamped with a vascular clamp. The radialis flap is now lifted as a fasciocutaneous flap and traced along the radial artery and the two accompanying veins into the elbow joint. There, the interosseous artery and the confluence sinuum of the accompanying venous plexuses are identified. The radial artery is now removed caudally and cranially. The accompanying veins are also removed. Then perfuse the harvested microvascular graft with heparin. The defect in the area of the forearm is then primarily covered. A full-thickness skin graft is then harvested from the area of the right groin. Oval incision of the skin region in the area of the right groin. Incision of the subcutaneous tissue. The skin area is then harvested in toto from the right groin. Smaller bleedings are coagulated, larger ones are stopped. A Redon drain is then placed. Subcutaneous suture. Skin suture. The removed skin is then freed from adherent fatty tissue and sutured into the defect in the left forearm as a split-thickness skin graft. The graft is then fitted into the soft palate. The transplant is sufficiently large. Communication is established with the right neck and the right oropharynx by bluntly entering the oral cavity/oropharynx after cutting through the digaster muscle. The stem of the transplant is then carefully pulled through this perforation into the neck. The radialis flap is then sutured into the defect. The radial artery flap is then microvascularly anastomosed by suturing the superior thyroid artery end-to-end with the facial artery and anastomosing the accompanying venous plexuses (confluens sinuum) end-to-side with the internal jugular vein. No evidence of leakage of the vascular anastomoses after removal of the vascular clamps. Careful irrigation of the wound. Placement of Redon drains on the right cervical and left cervical side. Subcutaneous suture, skin suture of the neck dissection incision on the right and left. Sterile wound dressing. Completion of the operation. Conclusion: Enormous tumor resection of a cT3 oral cavity oropharyngeal carcinoma, neck dissection on both sides, tracheotomy. Removal of a vascularized radial flap on the left and microvascular anastomosis of the flap on the right. The patient is admitted to the intensive care unit of our hospital postoperatively. Please continue antibiotics Unacid, 3 x 3 g. After receiving the definitive histology, the patient should be presented to the interdisciplinary tumor conference at our hospital.