(<CLINICIAN_NAME>) Pharyngoscopy and laryngoscopy: The exophytic tumor is visible, which leads from the anterior palatal arch via the tonsillar lobe, the alveolar ridge and the floor of the mouth to the edge and base of the tongue. Attempt at PEG insertion: Insertion with the esophagoscope. Advance into the stomach. However, diaphanoscopy cannot be established here and PEG placement cannot be carried out with sufficient certainty. The attempt to insert a PEG is therefore discontinued. If necessary, this would then have to be performed secondarily in surgery or internal medicine. Alternate positioning of the head and insertion of the McIvor blade or retractor. Exposure of the tumor. This runs from the anterior palatal arch over the alveolar ridge onto the floor of the mouth to the base of the tongue, which infiltrates minimally, with anterior infiltration of the edge of the tongue on the right. A tumor cone can also be felt in the edge of the tongue, individual satellites at the transition to the floor of the mouth. The tumor is now resected with a safety margin of at least 1 ˝ cm on all sides. The anterior palatal arch and the soft tissues above the alveolar ridge are removed, although the periosteal layer can be preserved here. The resection also includes the tonsil lobe with adjacent musculature, transition to the floor of the mouth, where the lingual nerve is exposed but can be preserved, as can the Wharton's duct. The resection leads over the floor of the mouth into the edge of the tongue, which is resected over a width of 1 to 2 cm in the posterior region, as is a small part of the base of the tongue. The preparation is thread-marked. Another separate marginal sample from the basal area of the tongue margin is also taken, here including a large slice of muscle. Both the entire specimen and the marginal specimen in healthy tissue, thus R0 resection in a frozen section. Indication for flap creation borderline. Due to the preserved posterior palatal arch, the coverage of the bone in the ascending mandibular branch and the still well-preserved mucosal area in the area of the glossoalveolar groove, the decision was made not to perform a flap here. Therefore, repositioning for neck dissection on both sides. (V. Bezas) Neck dissection on both sides and temporary tracheostomy. Initial repositioning for neck dissection on the right. Curved skin incision in typical manner. After cutting through the skin and subcutaneous tissue and the platysma, expose the anterior border of the sternocleidomastoid muscle. Partly sharp, partly blunt dissection and exposure of the important anatomical structures (omohyoid muscle, digastric muscle, infrahyoid muscles). Exposure of the cervical vascular sheath. Dissection of the internal jugular vein. Exposure of the internal jugular vein. Exposure of the common carotid artery, external carotid artery and internal carotid artery. Including exposure of the vagus nerve. Further dissection to the cranial side, here the hypoglossal nerve and the hypoglossal sac are exposed under the digastric muscle. Exposure of the nervus accessorius and free preparation of the neck dissectate from cranial to caudal. Further successive dissection and entrainment of the nodes from level II to V. The branches of the cervical plexus are preserved. Subtle hemostasis. Creation of a Redon drainage. Two-layer suture. Now proceed to neck dissection on the left side. Here the dissection is carried out in the usual way as on the right side. Here, however, with cN0 sonographic findings, the neck dissection is performed at levels II to IV. After careful hemostasis, irrigation with hydrogen and Ringer's solution. Application of a Redon drainage. Two-layer suture. Now proceed to permanent tracheostomy. Small Kocher's collar incision approximately 2 transverse fingers above the jugulum on the palpatory cricoid cartilage. Cut through the skin and subcutis. Expose the prelaryngeal musculature of the linea alba. Successive dissection in the midline and removal of the prelaryngeal neck musculature. Exposure of the thyroid gland. Palpation of the borders of the tracheal skeleton. Local coagulation and visualization of the upper limits of the thyroid isthmus. After clamping, local hemostasis and transection. Puncture ligatures and removal of the clamps. Visualization of the anterior wall of the trachea. Palpation and incision between the 2nd and 3rd tracheal cartilage in the sense of a visor tracheotomy. Subsequent suturing of the skin to the tracheal cartilage. Re-intubation and insertion of a tracheal cannula. This is fixed with suture. Transition to the oral cavity. After removing the compresses, the wound is inspected again. The bleeding is carefully stopped. At the same time, a nasogastric tube is inserted without any problems. Removal of all instruments and swabs. Completion of the operation. (<CLINICIAN_NAME>) Total cT2 to 3 oropharyngeal carcinoma R0 resected. Neck dissection with at least cN1 to cN2b status. Therefore evacuation of level II to V. Nutrition via the inserted gastric tube for approx. 1 week. Then, depending on the swallowing situation, a decision is made to insert a PEG, which should then be inserted in surgery or internal medicine. Waiting for the final histology and discussion of the patient in the interdisciplinary tumor conference.