After induction of anesthesia and intubation by the anesthesia colleagues, a pharyngo-laryngoscopy was performed to determine the extent of the tumor. A very superficially growing, slightly exophytic tumor with an uneven mucosal surface was found in the area of the vallecula. The tumor occupies the entire vallecula, passes centrally to the base of the tongue and extends over almost the entire surface of the lingual epiglottis as well as over the right edge of the epiglottis. Now first perform the PEG insertion. To do this, enter with the gastroscope under laryngoscopic control. Pre-insufflation into the stomach without any problems under constant air insufflation. If conditions are normal and diaphanoscopy is good, puncture the stomach and insert the PEG tube using the usual thread pull-through method without any problems. No abnormalities in the area of the esophagus on reflection. Now enter with the Steiner tube and visualize the findings. Successive removal of the very superficially grown tumor with constant correction of the spreading tube. Under the microscope, it can be seen that a tumor cone is also moving across the aryepiglottic fold towards the anterior piriform sinus wall. The superficial tumor is removed in the area of the epiglottis with the mucosa on the cartilage. The free right epiglottis margin and parts of the aryepiglottic fold are removed. This results in a complete resection of the vallecula with partial resection of the base of the tongue and partial resection of the epiglottis. This is followed by a post-resection, which corresponds to the tumor cones in the direction of the piriform sinus anterior wall. Marginal samples are taken in the area of the left vallecula and the base of the tongue. Due to the extensive tumor growth and the sometimes clearly dysplastic mucosal conditions at the tumor extensions, no further marginal samples are taken. Finally, when the wound is dry, the tracheotomy is performed due to the large area of the wound. A T-shaped incision is made below the cricoid. Cut through the subcutaneous tissue. Exposure of the prelaryngeal musculature. Expose the cricoid cartilage and carefully detach the thyroid isthmus, which is very thin here. Pronounced bipolar coagulation and separation of the thyroid isthmus. Exposure of the anterior tracheal wall and insertion between the 2nd and 3rd tracheal ring. Creation of a Björk flap and insertion of the tracheostoma in the usual manner. Now first perform the neck dissection on the left side. To do this, make a skin incision on the anterior edge of the sternocleidomastoid. Cut through the subcutaneous tissue and platysma. Creation of a platysmal flap. Exposure and preservation of the external jugular vein and the auricular nerve. Exposure of the anterior edge of the sternocleidomastoid. Exposure of the muscle. Exposure of the accessorius nerve. Numerous lymph nodes in the area of the venous angle and the accessorius triangle are already visible in the preliminary preparation. Now expose the omohyoid muscle. Trace the muscle and expose up to the hyoid. Expose the submandibular gland, taking the caudal gland capsule with it. Release in the direction of the hyoid. Exposure of the digastric muscle. Exposure of the facial vein. Now expose the cervical vein and in this layer release the anterior neck preparation while carefully preserving and exposing the superior thyroid artery as well as the vein and the hypoglossal nerve. Now free preparation of the vein while carefully protecting the lymph nodes lying on it. Cranial dissection up to the digaster, carefully protecting the accessorius, which runs over the vein and on which numerous nodes lie. In some cases very laborious dissection here, but no macroscopic lymph nodes exceeding the capsule. Clearing of the accessorius triangle and level V coming via the cervical sinus while carefully protecting the plexus branches. If the wound is finally dry, wound irrigation and two-layer wound closure after insertion of a 10 Redon drain. At the same time, perform the neck dissection on the right side. Here too, skin incision at the anterior edge of the sternocleidomastoid. Separation of the platysma. Exposure of the sternocleidomastoid muscle. A large lymph node conglomerate lying on the internal jugular vein can already be seen here. First visualization of the omohyoid muscle. Exposure of the submandibular gland and the digastric nerve. Now successive exposure of the lymph node conglomerate, which lies broadly against the facial vein and the internal jugular vein. Particularly difficult dissection here. The mass is directly adjacent to the vein and can only be separated from it in a final layer with great effort. Meticulous dissection is also required in the area of the nevus accessorius. Here, too, the mass is in direct contact with the vein. However, all the structures mentioned could be preserved. Separation of the mass. Then completion of the neck dissection. Successive clearing of level V with careful protection of the plexus branches. Similarly, complete anteriorly. Clearing out here, also protecting the hypoglossal nerve and the superior thyroid artery. If the wound is finally dry, final inspection and wound irrigation and, after insertion of a 10-gauge Redon drain and two-layer wound closure, completion of the procedure after final reintubation on an 8-gauge low-cuff cannula without any indication of complications. Conclusion: Neck dissection performed on the right side at the same time. Here too, skin incision at the anterior edge of the sternocleidomastoid. Separation of the platysma. Exposure of the sternocleidomastoid muscle. A large lymph node conglomerate lying on the internal jugular vein can already be seen here. First visualization of the omohyoid muscle. Exposure of the submandibular gland and the digastric nerve. Now successive exposure of the lymph node conglomerate, which lies broadly against the facial vein and the internal jugular vein. Particularly difficult dissection here. The mass is directly adjacent to the vein and can only be separated from it with great effort in a final layer meticulous Extensive vallecula carcinoma with cN2c neck status on the right side. Pronounced lymph node conglomerate in the area of the accessorius triangle and the venous angle, which was removed with considerable effort by a functional neck dissection. Due to the very superficial tumor growth and the broad extension as well as the expected further dysplastic mucosal conditions in the head and neck area and the adjuvant therapy that was certainly indicated, the tumor resection was performed without extensive covering of the marginal specimens. Treatment with tracheal cannula depending on postoperative swallowing function.  