After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and intubation of the patient. After fixation of the tube, the patient is positioned by the surgeon. Start of esophagogastroscopy. Insertion of the endoscope under visualization and constant air insufflation into the stomach. A typical gastric mucosal relief without irritation can be seen on all sides. After entering in inversion, the findings in the area of the gastroesophageal junction are also unremarkable. After desufflation, slow withdrawal of the endoscope with circular inspection of all esophageal sections. The mucosa is unremarkable on all sides. Remove the flexible endoscope. Insert the mouth guard and enter with the small bore tube. Initial inspection of the endolarynx, hypopharynx and esophageal entrance. This reveals normal conditions on all sides. This is followed by inspection of the oral cavity and the oral vestibule. With the exception of the large tonsillar carcinoma on the right side, the findings were otherwise unremarkable, with no evidence of a synchronous second tumor. Removal of the small drainage tube. Insertion of the McIvor oral spatula while protecting the teeth, lips and tongue. Palpatory exploration of the tonsil region. A transoral resection appears possible both by inspection and palpation. Therefore, first incision in the area of the soft palate laterally at the transition to the hard palate. Successive sharp and blunt dissection along the musculature while maintaining the necessary resection distance to the tumor. The resection is carried out taking a large part of the palatoglossus muscle with it. Laterally, the tumor extends into the parapharyngeal soft tissue. A displacement layer remains between the lateral tumor extensions and the external carotid artery. Initially blunt dissection laterally along the displacement layer caudally. Dorsally, the tumor extends to the posterior pharyngeal wall. Here too, resection is performed while maintaining the necessary safety distance. Caudally, the tumor extends to the base of the tongue. The tumor can be resected in sano both by inspection and palpation with the appropriate safety distance. A marginal sample is taken from the glossotonsillar margin to the base of the tongue and a marginal sample from the right parauvular margin. In the meantime, meticulous hemostasis using bipolar coagulation and insertion of H2O2-soaked compresses. During the frozen section by telephone, high-grade dysplasia is seen in the area of the marginal sample from the glossotonsillar to the base of the tongue. Therefore, an appropriate resection is performed here. Repeated hemostasis using bipolar coagulation. Due to the extent of the resection, especially laterally to just before the branches of the external carotid artery, a layer of Tachosil is now applied in the area of the lateral wound bed. In addition, the remaining muscles are mobilized and adapted to protect the cervical sheath. Adaptation is performed using Vicryl 3-0 RB1 sutures. As part of the adaptive suturing of the musculature, long-distance coagulation of a slightly larger venous vessel and clipping of a smaller artery is also performed. Both vessels are finally covered extensively in front of the adapted muscle layer. Very good aspect at the end of the operation. Due to the extensive resection area, the decision is made intraoperatively to create a protective tracheostoma. Repositioning of the patient and skin spray disinfection. Infiltration anesthesia. Skin wipe disinfection and sterile draping. Initial palpatory identification and color marking of the thyroid incisura and the level of the cricoid cartilage. Mark the planned incision approx. 1 QF below the level of the cricoid cartilage. Sharply cut through the cutis as well as the subcutis. Dissect the prelaryngeal musculature. Separation of the muscle bellies in the area of the linea alba. Exposure of the lower edge of the cricoid cartilage. Insertion of the retractors. Exposure of the thyroid isthmus. Undermining the thyroid isthmus using the Péan clamp. Bipolar coagulation of a relatively tender thyroid isthmus and lateralization of the two thyroid lobes. The anterior tracheal wall is now exposed over a large area. Enter between the 2nd and 3rd tracheal ring. First open the trachea. Creation of a visor incision and subsequent tension-free epithelization of the tracheostoma. Subsequently, easy transfer to an 8-gauge high-volume low-pressure tracheostomy tube. The patient can be ventilated easily and adequately via the tracheostomy tube. Application of the cannula tape. Finally, a nasogastric tube is inserted. This is done via the left nostril so that there is no manipulation in the area of the extensive wound bed. Final consultation with the anesthetist. Removal of the oral spatula and completion of the operation without complications.