First, after preparation by the anesthesia colleagues, inspection of the primary tumor. An exulcerated tumor of the left soft palate with a depleted uvula was found. Submucosal infiltration of the soft palate approx. 1 cm with a pronounced small cone of just under 2 cm on the left. The submucosal lesion extends to the upper pole of the tonsil, the suspicious change extends to half of the left tonsil, otherwise the tumor can also be palpated. First of all, perform the PEG insertion. To do this, enter with the gastroscope under laryngoscopic control. Easy advancement into the stomach. After excellent diaphanoscopy, problem-free puncture of the stomach and placement of the PEG tube size 15 Charričre using the usual suture pull-through method. Subsequent repositioning for tumor resection, this is done transorally. Insertion of the tonsil plug, cutting around the tumor with a safety margin of just under 1 cm. Resection with monopolar needle and dissection technique. Subtotal resection of the soft palate on the left. Resection up to the upper tonsil pole on the right, left-sided removal of the anterior palatal arch and performance of a tonsillectomy in the area of the regular and unchanged capsule. Deposition at the base of the tongue with macroscopically inconspicuous conditions. Completely covering marginal samples are now taken both on the specimen and in situ. These are diagnosed as completely tumor-free in the frozen section diagnosis. Therefore, intraoperative R0 situation, meticulous hemostasis and measurement of the defect measuring up to 8 x 5.5 in total in dry wound conditions. If tongue swelling has already clearly set in after tumor resection, a shot tracheotomy is performed later. First turn to neck dissection of the left side. To do this, make a submandibular incision approx. 2 QF below the lower jaw, cut through the skin and subcutaneous tissue. Exposure and transection of the platysma. Exposure and preservation of the external jugular vein, exposure of the sternocleidomastoid muscle, the omohyoid muscle and the digasatric muscle. Exposure of the submandibular gland, removal of the anterior neck preparation with careful protection of the cervical sinus, the hypoglossal nerve, the facial vein and the superior thyroid artery. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Clearing of the accessorius triangle and the upper level Va with careful protection of the cervical plexus branches. The submandibular gland is excised later. Subcapsular procedure and preservation of the oral branch. The facial vein is later removed for reasons of space. Exposure and preservation of the facial artery initially, which is later also ligated and removed. Resection of the digastric muscle. Entering pharyngeally at the level of the caudal tonsil lobes. Widen the pharyngotomy up to a width of approx. 3 QF, finally wide and soft conditions for subsequent pedicle positioning. Turn to the neck dissection of the right side. Also corresponding to the opposite side, skin incision, cutting through skin and subcutaneous tissue. Exposure and dissection of the platysma. Exposure and preservation of the external jugular vein. Exposure of the sternocleidomastoid muscle, omohyoid muscle, exposure of the submandibular gland and the digastric muscle. Release of the anterior neck preparation with careful protection of the cervical anus, the hypoglossal nerve, the superior thyroid artery and the facial vein. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Dissection of the accessorius triangle and the upper level Va, carefully preserving the cervical plexus branches. Final inspection and, if conditions are dry, wound irrigation, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Now turn to lifting the radialis graft from the left forearm. After marking the graft, which measures 9 x 5.5 in total and has a special soft palate configuration, the tourniquet is applied. Cutting around the graft. Exposure and entrainment of the distal cephalic vein. Performing the Haydn maneuver. Identification of the ramus superficialis nervi radialis. Ulnar exposure of the musculature, strictly subfascial approach here. Identification of the distal vascular pedicle, removal of the vasa radialia after ligation, strictly subfascial preparation, the ulnar vascular nerve bundle is not exposed. Subfascial release of the graft and proximal dissection after exposure of the strong ulnar artery, isolation of the radial artery, exposure and preservation of the common interosseous artery, exposure of a narrow bridge between the cephalic vein and the deep venous drainage system, but with strong venous confluence here, the deep venous confluence is later prepared for primary anastomosis. Isolation of the veins. Reopening of the tourniquet with excellent flap vitality Careful hemostasis is performed on the graft and the forearm. There is better venous flow for the deep draining vein, therefore ligation of the cephalic vein. A monitor was not used as the graft was clearly visible. Subsequently, the vital graft was removed after ligation of the draining vessels. The graft was then removed, the wound carefully closed in two layers and the full-thickness skin graft harvested from the right groin was inserted. Then application of the vacuum-sealing dressing and application of the stretcher splint in the functional site. Removal of the full-thickness skin graft. To do this, mark the graft oval, lift a graft of approx. 11 x 5 cm, cut around the oval, strictly cutaneous lifting. Careful subcutaneous mobilization. Subsequent insertion of a 10-gauge Redon drain with dry wound conditions and strong multi-layer wound closure. Subsequent skin suturing. The plastic tracheotomy was performed at the same time as the radialis graft removal. For this purpose, a horizontal skin incision was made at the level of the cricoid cartilage to separate the skin and subcutaneous tissue. Exposure of the infrahyoid musculature, separation of the musculature, exposure of the cricoid cartilage and the anterior surface of the trachea. Exposure of the thyroid isthmus, transection of the thyroid isthmus after ligation and repositioning. Insertion between the 2nd and 3rd tracheal ring. Creation of a broad-based pedicled Björk flap. Incision of the tracheostoma in the usual manner and subsequent problem-free reintubation to a size 9 low cuff cannula. After insertion of the graft from cervical to enoral, adaptive incision of the graft is performed, overall good fit, subsequent tightness on all sides. Left-sided positioning of the vascular pedicle. Conditioning of the flap vascular pedicle, followed by conditioning of the superior thyroid artery. Careful suturing of the arteries with 8.0 Ethilon. Due to the repositioning, the intake conditions were considerably more difficult, but subsequently the flow conditions were problem-free and sufficient and venous return was immediate and regular. Conditioning facial vein, which despite previous deposition ........ flow conditions. Measurement of a size 3.0 coupler and problem-free implementation of the venous anastomosis with the coupler, followed by good flow conditions and vital enoral graft, so that after final wound inspection, a 10-gauge Redon drain was inserted, careful two-layer wound closure and termination of the procedure with a vital graft and transfer of the patient to the intensive care unit. The patient received antibiotic prophylaxis with Unacid 3 g. Conclusion: Intraoperative R0 resected cT2 cN0 oral cavity carcinoma on the left, abstinence from food initially for 7-8 days, then with regular enoral healing, gradual food build-up and decannulation with regular swallowing function.