Induction of anesthesia and intubation by the anesthetist. Insertion of a covered retractor. Snaring of the tongue and inspection of the edge of the tongue. This reveals a bulging scarred change with 2 suture marks. In consultation with <CLINICIAN_NAME>, the R1 resection is in the posterior and lateral part, where a large area is resected. The resected area is thread-marked for the frozen section. The pathologist finds the margins to be free. Then the neck is dissected. Head positioning and sterile washing and draping. Curved skin incision on the anterior edge of the sternocleidomastoid muscle. Release of the sternocleidomastoid muscle in the anterior margin area. Exposure of the external jugular vein and preservation of this vein. Exposure of the omohyoid muscle, then the digaster muscle and the submandibular gland. Insertion of a retractor for below. Locate the accessorius nerve and expose the entire length of the internal jugular vein. Exposure of the cervical sinus. Exposure of the hypoglossal nerve. Clearing of levels IIa and b, then transition to levels III and IV and clearing of level V while sparing all plexus branches. Then visualization of the vagus nerve and the common and external and internal carotid arteries. Clearing of the anterior neck block while sparing the ansa as well as the V. facialis and the A. thyroidea superior. Now removal of level I. There were several enlarged lymph nodes in levels I, IIa and b, III and IV. Macroscopically no enlarged lymph nodes in level V, but to be on the safe side this level was also evacuated. Insertion of a Redon drain. Two-layer wound closure.