First, the patient is taken to the operating room, then the team time-out is carried out and active patient identification and consultation with anesthesia colleagues are performed. Induction of anesthesia and tracheobronchoscopy with the aid of the laryngeal blade and 0° optics. Entering the glottis and pre-mirroring up to the carina. Unobtrusive mucosal conditions on all sides of the carina, trachea, vocal folds, subglottic and glottic area. Then intubation by the surgeon. The surgeon then positions the head and inspects and palpates the oral cavity and oropharynx. The right tonsil is more palpable than the left tonsil. The base of the tongue is palpably unremarkable and soft, as are the tongue and the floor of the mouth. Now re-inspect the oropharynx, larynx and hypopharynx with the type C small bore tube. This reveals the tonsil with a small ulcer, possibly suspicious. Otherwise, the base of the tongue, the vallecula, the epiglottis, the piriform sinuses on both sides, the aryepiglottic folds, the arytenoid cartilage, the glottic plane, the vocal folds and the epiglottis, posterior pharyngeal wall and posterior and lateral walls of the hypopharynx are unremarkable. On the right paramedian posterior wall of the oropharynx, the ACI is visible both by inspection and palpation; it does not reach the tonsil lobe. Now insert the McIvor oral spatula while protecting the lips, teeth and tongue. Demonstration of findings to <CLINICIAN_NAME>. In the case of primary tonsillitis in the tonsil larynx, tonsillectomy, which goes to the frozen section. The tonsil is grasped at the upper pole and a parauvular mucosal incision is made, which is extended cranially as well as ventrally and dorsally caudally. The tonsil is dissected out along its capsule using a rasparator and deposited very far caudally at the base of the tongue after bipolar coagulation. The tonsil is marked with a suture in the area of the wound base, where the tumor is most likely to be palpated, and caudally at 6 o'clock. The tonsil lobe is free of tumor on inspection and palpation. The tonsil goes to the frozen section. Here, the wound base is marginally R0 less than 0.1 cm, and also marginally R0 ventrally at 9 o'clock in the direction of the anterior palatal arch, but with margin-forming CIS. The remaining caudal, dorsal and cranial margins are free. After consultation with <CLINICIAN_NAME>, resection in the sense of a margin sample in the wound bed, this is thread-marked for final histology, marked cranially in the wound bed of the wound bed and marked ventrally towards the anterior palatal arch. In addition, resection of the anterior palatal arch marked cranially with a suture and then another marginal sample of the anterior palatal arch consisting of 2 parts, each marked cranially with a suture. Now detailed hemostasis by means of bipolar coagulation. Macroscopically no more evidence of tumor. The ACI is not in the area of the resection bed, but close enough. No opening towards the neck. Insertion of hydrogen swabs. Repeated inspection using a small mirror. No further bleeding. Unblocking, head elevation. No further bleeding. Now insertion of a PEG in the typical manner using the pull-through technique after a clear diaphanoscopy and after disinfection of the upper abdomen. This was successful without any problems. The procedure was completed without complications and the surgeon repositioned the head. Conclusion: V.a. cT1 cN2b tonsillar carcinoma, in the frozen section margin-forming CIS on the anterior palatal arch and squamous cell carcinoma marginal R0. Subsequently, further marginal samples were taken at the base of the wound and on the anterior palatal arch. Awaiting the final histology. Two-stage neck dissection. To be on the safe side, clarification for flap coverage in case an oropharyngeal fistula could develop as a result of the neck dissection.