Start of surgery with tracheoscopy with unremarkable findings. Subsequently intubation and pharyngoscopy as well as laryngoscopy with the Kleinsasser tube (C-tube). An exulcerated tumor measuring approx. 4 x 2 cm was found in the area of the edge of the tongue and floor of the mouth on the left, from which a biopsy was taken for frozen section diagnosis. In addition, there is a leukoplakia behind the last molar on the left alveolar ridge of the mandible. The left tonsil also shows a discrete lesion, which is also biopsied. The previously described leukoplakia is removed by excisional biopsy. This is followed by esophagogastroscopy with a flexible instrument and placement of a PEG. After PEG placement without complications, enoral tumor resection is performed. Now the tumor is gradually bypassed with the monopolar needle at a macroscopic safety distance of 1 cm. As soon as the deep soft tissue gives way, a corresponding safety distance is maintained. The tumor extends from the anterior third of the tongue on the left over the entire dorsal edge of the tongue to approx. 1-2 cm into the base of the tongue. The tumor also reaches the glossotonsillar groove. After carefully moving around the tumor with the monopolar and removing the resected specimen, it is marked and sent for frozen section diagnostics. Neck dissection follows on the left side with a submandibular skin incision approx. 2 QF below the mandible and, after appropriate skin incision, preparation of the cranial and caudal platysmal flaps. Sparing of the external jugular vein and the auricularis magnus nerve. Dissection of the anterior edge of the sternocleidomastoid muscle up to the vascular nerve sheath. Dissection along the omohyoid muscle to the hyoid bone and along the diagstricus muscle to the laterobasis. Dissection along the internal jugular vein after previous exposure and securing of the accessorius nerve. Lifting of the level II, III and IV neck block while sparing all nerves and vascular structures. This is followed by the removal of level V with protection of the accessorius nerve, the cervical accessorius plexus and the cervical plexus. Enlarged lymph nodes are particularly evident in the area of level II. Level Va also shows enlarged lymph nodes in the cranial area. After careful removal of the corresponding regions, the submandibular gland is dissected and removed. The surrounding lymph nodes of region Ib are also carefully removed. Care is taken to protect the marginal ramus and facial nerve. Finally, the ligation of the lingual artery is performed due to the extensive partial resection of the enoral tongue. Irrigation of the wound, careful hemostasis and insertion of a 10-gauge Redon drain. Suturing of the platysma, subcutaneous sutures and skin sutures. After the frozen section has revealed submucosal carcinoma infiltrates, the corresponding areas are resected again and final margin samples are taken. These final margin samples now reveal a carcinoma-free finding in the frozen section diagnosis. Once again, careful hemostasis is carried out before a tracheostomy is performed due to the extensive resection area, the associated risk of swelling and bleeding and the predicted difficulty in swallowing. This involves a jugular skin incision and dissection of the subcutaneous tissue and prelaryngeal muscles. Dissection of the thyroid isthmus at the level of the cricoid cartilage. Undercutting of the isthmus and careful coagulation of the isthmus. Exposure of the anterior surface of the trachea, creation of a caudally pedicled suture in the sense of a Björk flap. Suturing of the Björk flap with 2 fixation sutures and a cranial suture of the stoma. Lateral skin sutures. Transfer to an 8-gauge Rüsch cannula with blocking. Sterile wound dressing.