After intubation by the anesthesia colleagues, start with PEG insertion: Entering the stomach under continuous air insufflation. Careful diaphanoscopy and air insufflation. PEG placement in the usual manner without complications. Now start with endoscopy. Entry with the Kleinsasser C-tube and inspection of the pharynx. A coarse, verrucous, already histologically confirmed tumor formation can be seen on the right side at the dorsal edge of the tongue at the junction of the glossotonsillar groove and at this point also radiating into the right base of the tongue. The palatine tonsil is not reached clinically. The midline is far away on palpation. The base of the tongue is infiltrated on the right side in the upper third about 2 cm cranial to the vallecula. Now the remaining hypopharynx, the vallecula, the epiglottis and the endolarynx are reflected. Inconspicuous conditions here. Then adjust the tongue with the self-retaining retractor and rein suture. Determination of the resection margins, which are clinically clearly in the healthy area. Then resection of the tongue tumor with the electric needle and in between with bipolar coagulation and scissors. The tumor preparation can be resected en bloc. The lingual artery does not have to be resected and the hypoglossal nerve is not exposed. The tumor specimen is now marked with sutures and is then sent to the frozen section. The medial edge, the lateral edge and the base of the tongue are each thread-marked. During the operation, the pathology department informs the surgeon that the specimen has been resected R0. Now hemostasis with the bipolar forceps. Laterally, it can be seen that a part of the palatine tonsil is also removed in the sense of a generous resection. Precise hemostasis here. Subsequent insertion of hydrogen swabs and turning to neck dissection on the right. Ultrasonographic status here cN2b ............2. Now instillation of 10 ml xylocaine without adrenaline in the area of the anterior edge of the sternocleidomastoid. Abjode, sterile draping and skin incision. Cut through the subcutaneous tissue and the platysma. Ligation of the external jugular vein and transection of the same. Now expose the anterior border of the sternocleidomastoid muscle, the internal jugular vein and the common carotid artery as well as the vagus nerve. It can now be seen that the cranial accessorius nerve extends into the neck metastasis at level 2. This metastasis virtually fills the upper accessorius triangle. The decision was made to resect the accessory nerve and to partially resect the sternocleidomastoid muscle in this region. Sharp detachment of the tumor metastasis from the upper accessorius triangle while sparing the vascular structures. This is successful. Now better view of the internal jugular vein. Sharp removal of the tumor conglomerate from the digaster venter posterior muscle. The V. is then exposed from caudal to cranial and finally the entire posterior neck preparation is removed while sparing the plexus branches. Now expose the hypoglossal nerve. Then complete the anterior neck by removing the capsule of the submandibular gland and anterior lymphatic tissue. Now expose the common carotid artery, the outlet of the internal carotid artery and the external carotid artery. Identify the superior thyroid artery, the lingual artery and the facial artery. The lingual artery is now effectively ligated. Subsequent irrigation with hydrogen and Ringer's solution, followed by hemostasis and placement of a 10-gauge Redon drain. Two-layer wound closure and repositioning to the opposite side. Here also instillation of 10 ml xylocaine and addition of adrenaline. Skin incision in the area of the anterior edge of the sternocleidomastoid. Exposure of the sternocleidomastoid muscle and the cranial accessorius nerve. The omohyoid muscle caudally, the cervical vascular sheath in the sense of the internal jugular vein, common carotid artery and vagus nerve. Now expose the accessorius nerve and finally free the upper accessorius triangle. Finally, detach the posterior neck preparation while sparing the plexus branches. Complete the anterior neck by removing the capsule of the submandibular gland and the remaining lymphatic tissue. The vagus nerve is also exposed. Subsequent irrigation with hydrogen and Ringer's solution. Insertion of a 10-gauge Redon drain and, after meticulous hemostasis, two-layer wound closure. Now repositioning for tracheotomy: modified Kocher collar incision, dissection of the subcutaneous tissue and cutting of prethyroid veins. Subsequent exposure of the cricoid cartilage and undermining of the thyroid isthmus. Removal of the latter after repositioning, exposure of the anterior wall of the trachea and insertion between the 2nd and 3rd tracheal cartilage. Creation of a Björk flap in ................. and epithelization of the tracheostoma. A 9-gauge tracheostomy tube is finally inserted. The patient receives Unacid 3 x 3 g intravenously. Finally, the swabs are again removed from the mouth area, blood is stopped again and the open wound edges are adapted using Vicryl sutures.