First, transfer the patient to the operating theater. Then active patient identification and team time out. Consultation with the anesthesia department. Then induction of anesthesia and intubation by the anesthesia colleagues. Then head positioning by the surgeon and insertion of the Mc Ivor mouth spatula, taking into account the teeth, lips and tongue. Repeated inspection and palpation of the base of the tongue and tonsils. Only the left tonsil is found to be discreetly hardened, otherwise there is no suspicious mass, either by inspection or palpation. Tonsillectomy on the right side first. To do this, grasp the upper pole of the tonsil and dislodge it. Then make a parauvular mucosal incision and extend it caudally. Successive dissection along the tonsil capsule from the upper pole to the lower pole using raspa and scissors. Occasional bipolar coagulation. Separation of the tonsil at the lower pole after extensive bipolar coagulation. Inspection of the wound bed using an angled mirror. Isolated bipolar coagulation at the lower tonsil pole, then no further bleeding here. Isolated bleeding at the upper tonsil pole, also here biopolar coagulation, then no further bleeding. Insertion of hydrogen swabs on the right side and turning to the left side. Here too, grasp the tonsil at the upper pole and dislodge it. This is somewhat more difficult than on the opposite side. Parauvular mucosal incision and extension of the same with an approx. 0.5 cm wide margin. Now dissect the upper pole of the tonsil capsule. After a short time, it becomes apparent that this is more difficult and the upper tonsil pole appears to be cemented to the base. Demonstration of findings on <CLINICIAN_NAME>. Further tonsillectomy on the left using scissors and raspa. In the lower third, the preparation is much more successful, in the upper third an attempt was made to resect the adhesions and hardening completely in toto. The tonsil is easily removed at the lower pole after extensive bipolar coagulation. Then hemostasis at the lower tonsil pole. Only occasional focal hemostasis at the upper tonsil pole. The tonsil is suture-marked for frozen section. Long long upper cranial tonsillar pole, short long lateral tonsillar margin and short short dorsal cranial tonsillar pole. The right tonsil also goes to the frozen section. The right tonsil is free of carcinoma. On the left tonsil, there is basaloid squamous cell carcinoma at the cranial tonsillar pole up to the medial margin, matching the lymph node metastasis. The lateral tonsil margin and the dorsal cranial tonsil pole were free. Subsequent demonstration of findings at <CLINICIAN_NAME> and <CLINICIAN_NAME>. Subsequent resection by <CLINICIAN_NAME>. First, a posterior resection is performed on the posterior palatal arch medially and a posterior resection on the anterior palatal arch laterally and at the base of the wound caudally. These resections are sent for final histology. Subsequently, marginal samples are taken and sent for frozen section, namely the medial posterior palatal arch, lateral anterior palatal arch and cranial anterior palatal arch. In addition, the cranial wound bed and caudal wound bed as well as the caudal margin. The frozen section also shows squamous cell carcinoma on the posterior palatal arch medially and, according to the pathologist, a carcinoma in situ in the cranial wound bed and non-assessable tissue in the caudal wound bed. For this reason, <CLINICIAN_NAME> subsequently performs another extensive resection in all areas of the previous margin samples. A final marginal sample is therefore taken from the caudal wound bed, a second resection is performed in the cranial wound bed, a final marginal sample is taken from the cranial wound bed, a second resection is performed on the medial posterior palatal arch and, last but not least, a final marginal sample is taken from the medial posterior palate. The areas of the previously described R1 resection are thus covered and a macroscopic R0 situation is present, resulting in the prolapse of fatty tissue at the lateral tonsillar margin, which is coagulated. However, there is no fistula in the direction of the neck. The posterior palatal arch is ultimately only marginally protruding. An adapting suture is placed in the area of the soft palate. The samples are now sent for final histology. Hemostasis is performed. No further signs of bleeding here. Unblocking after sufficient waiting time. Repeated inspection. No further bleeding here. A nasogastric tube is inserted and its position checked. Air can be auscultated in the stomach and gastric juice aspirated. Now turn to neck dissection on the left: The surgeon first positions the head. Then infiltration anesthesia with 6 ml Ultracaine 2% in the area of the planned incision. Then skin disinfection and sterile draping of the surgical area. Now mark the skin incision, which curves along the anterior edge of the sternocleidomastoid, and mark landmarks on the mastoid, mandible and jugulum. Now cut through the skin and subcutaneous tissue. Then cut and expose the platysma. The external jugular vein is cut in the process. Then expose the sternocleidomastoid, the omohyoid, the submandibular gland and the anterior and posterior digaster venter. Subsequently, clearing of the anterior medial neck dissection specimen while sparing the facial vein, the superior thyroid artery, the hypoglossal nerve, the internal jugular vein and the cervical vein. Subsequent visualization of the accessorius nerve. Larger veins are ligated individually. Subsequent clearing of the accessory triangle. Dissection of the internal jugular vein and exposure of the external and internal carotid arteries and exposure of the vagus. Now clearing of the lateral neck triangle from level IV to level II with transition to level Va. Careful protection of the cervical plexus branches. Subsequent wound irrigation with Ringer and wound inspection. Isolated bleeding here. These are stopped using bipolar coagulation. Now no further bleeding. Wound irrigation again. Now dry wound conditions. Subsequent insertion of a 10-gauge Redon drain and careful two-layer wound closure. Head repositioning by the surgeon and completion of the procedure without complications. Conclusion: suspected cT1 cN2b tonsillar carcinoma on the left. Neck dissection from level II to level Va and tumor tonsillectomy on the left. The first resection revealed focal squamous cell carcinoma on the posterior medial palatal arch as well as CIS in the cranial wound bed and non-assessable conditions in the caudal wound bed. For this reason, a second resection was performed with final margin samples, which were sent for final histology. In R0, the swallowing function should be awaited; if this does not appear sufficient, flap coverage is possible before adjuvant therapy. In the R1 situation, presentation at the tumor conference and planning of a subsequent resection with flap coverage and discussion of a contralateral neck dissection.  