First pharyngoscopy and laryngoscopy: After reclination of the head and insertion of the mouth guard, insertion of the small bore tube size C and B. The described tumor, previously described as cT1, is seen in the area of the glossoalveolar groove/base of tongue junction. Tumor is exulcerated. Further examination reveals an uneven mucosa in the area of the vallecula transition lingual epiglottis. A sample is taken here, which is sent for frozen section. The frozen section shows squamous cell carcinoma. Thus somewhat more extensive growth than known. Now adjustment of the tumor. Laser resection with 4 to 12 watts. Resection is now performed around the tumor with a safety margin of at least 1 cm on all sides. Resection proceeds from the lateral pharyngeal wall via the base of the tongue to the vallecula area to the left until microscopically healthy mucosa appears. Laterally, the resection goes into the pharyngeal muscle. Infiltrative growth is clearly visible here, so that the soft tissue, especially in the base of the tongue, must be resected more deeply. Resection extends to the hyoid bone. Caudally, the resection extends into the piriform sinus. Laterally to the edge of the left vallecula, it also includes the entire part of the lingual mucosa of the epiglottis and the caudal base of the tongue. The specimen is thread-marked for frozen section. There are still infiltrates caudally in the direction of the piriform sinus and laterally to the left in the direction of the vallecula. After consultation with the pathologists, no tumor infiltrates. At the same time, a marginal sample taken from the base of the tongue was unremarkable, as was the mucosa taken from the lingual epiglottis on the left. Thus, tumor infiltrates of the marginal sample of the left lateral vallecula, which was thread-marked, and the marginal sample of the caudal piriform sinus and, after evaluation of the tumor specimen, laterally towards the pharyngeal wall. Therefore, another extensive resection of the mucosal tissue from the left vallecula to the left pharyngeal wall was performed. Subsequently, a marginal sample is taken at the transition from the epiglottis to the left pharyngeal wall, which is also thread-marked for the frozen section. No more infiltrates here. The tonsil blocker is then inserted and an extensive resection is performed from the base of the tongue via the tonsil lobe to the lateral palatal arch. A strip of mucosa measuring at least 1 to 1.5 cm is resected here. Then a lateral margin sample is taken, which is marked with a thread. This marginal sample is also tumor-free. A resection is then performed from the caudal area or the piriform sinus, at least 1 to 1.5 cm wide. Then a marginal sample is taken from the caudal area or piriform sinus. This shows tumor infiltrates in the frozen section, whereby the tumor does not grow in the mucosa but in the underlying muscle layer. The right basal margin sample was tumor-free. The overall picture is that of a very extensive G3 squamous cell carcinoma growing like a sheet, which has grown into the soft tissue anteriorly towards the hyoid bone and in particular has undermined the mucosa and grown caudally into the piriform sinus and cannot be resected R0 from transorally. Overall, a wallpaper-like or mosaic-like, flat growth. Due to the overall situation, initial indication for tracheostomy. This is performed by <CLINICIAN_NAME> and <CLINICIAN_NAME>. (<CLINICIAN_NAME>) Tracheotomy: Now transition to tracheotomy. Injection of local anesthetic and sterile draping in the usual manner. Then mark the important landmarks and make the skin incision just below the cricoid cartilage. Dissection under bipolar coagulation through the cutaneous fatty tissue. Exposure of the straight neck muscles and transection in the linea alba. Push the muscles laterally. Subsequent careful dissection of the cricoid cartilage. This works well. Now undermine the thyroid isthmus and coagulate the isthmus in detail and carefully cut through it. Exposure of the cricoid cartilage and the trachea. This is also successful. Therefore, incision between the 2nd and 3rd tracheal clasp and suturing of the skin cranially and caudally. Then carefully withdraw the tube and insert the tracheal cannula. This is successful without any further problems. The tube is then removed in the usual manner. Then re-inspection of the oropharynx and extensive coagulation in the resection area by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Ultimately, many isolated bleedings can still be stopped. Termination of the procedure without bleeding, without complications. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Overall, very extensive growth of a G3 squamous cell carcinoma, mainly extensive and undermining the mucosa, partly also extending into the soft tissue. Due to the overall situation, it is highly questionable whether extensive surgery, especially from the outside, is advisable, as the entire hypopharynx may fall and a flap plasty may occur, resulting in significant dysphagia. Dysphagia is pre-programmed anyway due to the extensive laser resection, hence tracheotomy. Neck dissection should be performed in the interval after approx. 10 to 14 days, which was no longer performed due to the resection of the pharynx from the inside. Finally, after neck dissection, indication for radiochemotherapy.