After appropriate preparation by the anesthesia department, the PEG is first inserted by <CLINICIAN_NAME>. The PEG is inserted and secured using the usual technique. Then transition to tracheostoma placement. After skin disinfection, infiltration with local anesthetic containing adrenaline in the area of the subsequent skin incision as well as the tracheostoma. Sterile washing and draping. Skin incision approx. 2 QF above the jugulum. Sharp dissection through the subcutaneous fatty tissue down to the prelaryngeal musculature. This is divided along the linea alba. Exposure of the very strong isthmus of the thyroid gland. The isthmus is then passed under the pretracheal lamina, clamped and repositioned. This clearly exposes the upper trachea and the cricoid cartilage. The visor tracheotomy is then performed between the 2nd and 3rd tracheal cartilage. Creation of the mucocutaneous anastomosis with 2 sutures each cranially and caudally. Problem-free reintubation of the patient. Then transition to tumor resection. Here, the tumor is positioned with the tonsil retractor. The ulcerative tumor in the area of the right oropharynx, dorsal to the posterior mandibular molar, is not very well defined. First start with caudal tumor resection. The adjacent base of the tongue is biopsied first, which is found to be tumor-free on frozen section histology, as is the adjacent maxilla. Now first cut around the resection margins caudally in the area of the medial base of the tongue in a lateral direction towards the mandible. The mucosa of the lateral floor of the mouth is incised up to the penultimate premolar. The resection is then guided laterally over the gingiva between the last and penultimate molars and continues in an arc over the adjacent buccal mucosa cranially to the maxilla. From there, the right soft palate is parauvularly incised almost to the midline. The resection then proceeds, including the posterior palatal arch, to the back wall of the pharynx, where it is then rejoined at the lower pole of the tonsil or base of the tongue. During resection, the last morale on the right side is then removed. The tumor is then successively resected along these borders together with the surrounding soft tissue. The posterior part of the lingual nerve is exposed and must also be resected in order to maintain an appropriate safety distance. Finally, the tumor can be completely removed by pushing the periosteum away from the mandible and thus completely exposing the mandibular angle from the medial side down to the bare bone. Multiple frozen section histological samples are taken from the surrounding resection margin as well as from the base of the tumor, all of which prove to be tumor-free. The last molar on the right side is then extracted and the adjacent mandible is ground out with the drill and smoothed. Also the root canals. After tumor resection, measurement of a 9 x 6.5 cm long radial flap graft, which will be lifted from the left forearm by <CLINICIAN_NAME>. Distal skin incision and dissection through the subcutaneous fatty tissue. Expose the cephalic vein and dissect radially from it. Exposure of the muscle bellies of the flexor carpi radialis and brachioradialis muscles and exposure of the venous star as well as exposure of the pedicle in depth. Now free dissection of the muscle bellies distally and exposure of the complete pedicle. Dissection of the cephalic vein and the radial vein as potential connecting vessels. Exposure of the brachial and ulnar arteries and exposure of the proximal end of the radial artery. Clipping of small perforator vessels and ligation of larger veins and arteries. Now ulnar recutting of the flap while sparing the ulnar artery and dissection up to the flexor carpi radialis tendon. Now also radially recut the flap and follow the cephalic artery distally. This is included in the subcutaneous fatty tissue of the graft. The R. superficialis of the radial nerve can be preserved with its two branches. Separation of the cephalic vein distally. Complete removal of the transplant. Finally, removal of the radial artery distally and proximally and removal of the two venous outlets. Ligation of the vascular stumps. Arm closure after careful hemostasis using a split-thigh skin graft of the right thigh, which was obtained in the usual manner. Application of a plaster splint. Good recapillarization time after removal of the flap. Subsequent transition to neck dissection on the right side. After skin incision, dissection and skeletonization of the sternocleidomastoid muscle. Then expose the cervical vascular nerve sheath caudally and dissect cranially, sparing all non-lymphatic structures. Regions II to V are thus completely cleared out first. Submandibulectomy and removal of region I are then performed. In the area of the submandibular lobe, the pharyngeal passage into the defect is also found. Insertion of a Redon suction drainage. Subsequently, transition to neck dissection on the left side. Here, regions II to V are completely evacuated while preserving all non-lymphatic structures. After placement of the radial lobe graft, it is then inserted into the oropharyngeal defect from the lateral side via the previously created access and initially fixed to its cranial attachment site with several sutures. Then suture via the transcervical access of the caudal flap edge. Finally, the flap is fixed in position with the remaining sutures from the transoral side. The microvascular anastomosis is then performed. The arterial anastomosis is performed with the ascending pharyngeal artery, as both the superior thyroid artery and the facial artery are extremely small in caliber. The venous anastomoses are performed in the usual manner via 2 veins to the internal jugular vein using the end-to-side technique. Finally, insertion of a drainage flap in the right side of the neck. Two-layer wound closure. End of the operation, transfer of the patient to the anesthesia department after the patient has been reintubated onto an 8-gauge tracheostomy tube, which is sutured to the skin. Prior to this, wound closure on the left side after insertion of a Redon suction drain. End of the operation, transfer of the patient to anesthesia. Conclusion: Transoral tumor resection of a cT3 oropharyngeal carcinoma on the right side in the region of the mandibular angle with extraction of the last molar from the right mandible and corresponding grinding of the adjacent bone. Microvascular reconstruction with a radial flap graft from the left forearm and defect coverage on the left forearm with split skin from the right thigh, creation of a tracheostoma and a PEG.