Initially bronchoscopic intubation by the anesthesia colleagues. This is initially much more difficult in the case of massive tumor formation in the epiglottis area. The patient is then positioned by the surgeon. Entry with the small bore tube and inspection of the inconspicuous oral cavity. Inconspicuous tonsils and posterior pharyngeal wall. The base of the tongue itself is also inconspicuous, but there is a submucosal tumor formation directly in the vallecula, and the epiglottis is massively distended and depleted. As described above, the tumor extends on the right side over the aryepiglottic fold up to the arya. The aryepiglottic fold is reached on the left side. The tumor formation breaks through the epiglottis towards the supraglottis. As far as can be assessed, the glottic plane itself is free. Certainly no growth towards the subglottic. Several sufficient samples are now taken in the sense of a circumscribed tumor debulking. These are sent for frozen section diagnostics. This shows a poorly differentiated carcinoma, which, however, most likely corresponds to an adeno- or adenoid cystic carcinoma. After discussing the case with <CLINICIAN_NAME>, either a primary adenoid cystic carcinoma or a metastasis can be considered. Therefore, case discussion with <CLINICIAN_NAME> and <CLINICIAN_NAME>. Another review of the CT/thorax. Here, as described above, no suspicious changes. Due to the extensive, massive clinical findings, confirmation of the indication for tumor resection with laryngectomy in the case of both differential diagnoses. Then repositioning. Injection of xylocaine with added adrenaline. Skin incision in the sense of a modified Gluck Sorensen. Cut through skin and subcutaneous tissue. Separation of the platysma. Creation of a platysma flap on both sides. Antero-completion of the platysmal flap. Creation of the apron flap. Suture of the apron flap upwards. An external jugular vein is only present and preserved on the right side, as is the auricular nerve on both sides. Exposure of the sternocleidomastoid muscle and the omohyoid muscle. Initially starting with the left side: free dissection of the sternocleidomastoid muscle already reveals a clinically clear lymph node metastasis in level III, contact of the muscle, but with clear connective tissue separation, so that the muscle is preserved here. Visualization of the omohyoid muscle, visualization of the submandibular gland. This is somewhat coarsely altered, but without any suspicious changes. Visualization of the digastric muscle. Release of the anterior neck preparation while carefully protecting the superior thyroid artery. Due to the location of the metastasis, the facial vein must be ligated and removed. Now free dissection of the internal jugular vein. Throughout the course of both neck dissections, there are clearly vulnerable vessels. Vessels have to be ligated several times. Dissection of the internal jugular vein. Repeated hemostasis, but overall continuity-preserving exposure, exposure and exposure of the common carotid artery, exposure of the bulb, exposure and preservation of the hypoglossal nerve. Several, not necessarily suspicious lymph nodes in the area of the jugulo-facial angle. Exposure of the accessorius nerve. Release of the accessorius triangle. Finally, release of level V with visualization and preservation of the vagus nerve and caudal phrenic nerve. Exposure and selective coagulation of the thoracic duct. Finally, absolutely dry conditions here. Final wound inspection and with dry and cleared conditions, detachment of the infrahyoid musculature on the left side. Skeletonize the left side of the larynx. Exposure of the hyoid. Exposure of the posterior horn of the thyroid gland and selective ligation of the laryngeal bundle. Now turn to the opposite side. In principle the same procedure here. Exposure of the sternocleidomastoid muscle. Here, too, a metastasis-specific mass in level III, located on the internal jugular vein, can be seen at exactly the same location as on the opposite side. The muscle can be separated from this. Cranially in level II a clinically clear lymph node metastasis measuring approx. 3 cm. The muscle can also be preserved with a clear connective tissue separating layer. Visualization of the omohyoid muscle. Exposure of the submandibular gland and the digastric muscle. Here too, the facial vein must be ligated and ligated after injury and in the presence of metastases. All in all, difficult dissection conditions with extremely vulnerable vessels and multiple vascular injuries. Free dissection of the internal jugular vein and double vascular suture. However, here too, exposure preserving continuity overall. Exposure and preservation of the accessorius nerve. This can also be easily detached from the metastasis. Release of the accessorius triangle and release of level V, also exposing the vagus nerve and the phrenic nerve and preserving the structures, also preserving the cervical plexus. Anteriorly, the superior thyroid artery and the hypoglossal nerve were preserved. Now, after wound inspection and interim demonstration of findings on <CLINICIAN_NAME>, detachment of the infrahyoid musculature on the right side and skeletonization of the larynx. Exposure of the cricoid cartilage and the anterior surface of the trachea. Overall relatively high larynx. Exposure of the first 3 to 4 tracheal clasps. Exposure of the thyroid cartilage horn. Selective coagulation of the laryngeal bundle. Exposure of the hyoid. Now detachment of the perichondrium from the thyroid cartilage on the right side. Now, after dislocation of the hyoid, entry laterally on the right above the hyoid. The entrance here is in the area of the pharyngeal side wall, slightly above the vallecula and at a safe distance of approx. 1 cm from the tumor. As described above, the tumor is located submucosally in the vallecula, consuming and breaking through the epiglottis. A strip of the base of the tongue is resected to obtain a safety margin, but there is clearly no macroscopic or palpatory infiltration. Resection of the tumor with a good 1 cm safety margin and soft tissue on all sides in the depth. The hypopharyngeal side wall, especially the piriform sinus, is free on all sides. Resection along the aryepiglottic fold and narrow postcricoidal separation here. This region is far from being reached by the tumor. Now release the laryngeal skeleton while carefully preserving the pharyngeal tube and maintaining a strong muscle mantle. Careful protection of the oesophagus and then tracheotomy. Resection of 2 tracheal clips with relatively high trachea. Angled removal of the trachea and thus the tumor. Snaring and incision of the trachea anteriorly. Now inspection of the tumor and consultation of <CLINICIAN_NAME>. It can now be seen that the tumor, as already described above, moves through the epiglottis towards the supraglottis, moves on the right side towards the arya, infiltrates the pocket fold here, the glottic plane itself is free, as is the subglottis. Now confirmation of the macroscopic in sano resection on the specimen. The tumor is also surrounded on all sides by a soft tissue mantle in depth. The specimen is now thread-marked for frozen section diagnostics and is classified as R0. Therefore, if the pharyngeal mucosa is sufficient and the pharyngeal tube is strong, primary wound closure or reconstruction with local mucosa is performed. Careful submucosal pharyngeal suture with 3.0 SH plus. Countersinking of the corners in the area of the base of the tongue and the caudal pharyngeal suture. Then muscle suture and stitching over the thyroid gland and infrahyoid muscles. Finally, stable pharynx sutured in several layers. Strong adaptation also in the area of the base of the tongue. Final wound inspection of all circumscribed wound cavities. Final hemostasis. Irrigation of the wound with Ringer's solution and, in dry conditions, insertion of a 10-piece Redon drain. Completion of the incision of the tracheostoma with mucocutaneous anastomosis and finally careful, two-layer wound closure and reintubation with a 10-gauge tracheoflex cannula and completion of the procedure at this point without any indication of complications. Conclusion: Intraoperative R0 resected cT4a cN2c oropharyngeal carcinoma. Depending on the definitive histology, adjuvant therapy is indicated. If histology indicates a metastasis, extended staging may be necessary. If the wound is normal, please swallow gruel on the 8th to 9th postoperative day.