Transfer of the patient to the operating room. Active patient identification. Carrying out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and problem-free intubation after inconspicuous tracheoscopy. Start of PEG insertion. Problem-free insertion of the endoscope into the oesophagus and pre-scopy into the stomach. Inconspicuous conditions on all sides. If the diaphanoscopy is positive, problem-free PEG insertion using the thread pull-through method. Application of a wound dressing. Start with CUP panendoscopy. Initial tonsillectomy on the left side. Parauvular mucosal incision, which is continued to the base of the tongue. Exposure of the tonsil capsule. Dissection of the upper polar vessels, bipolar coagulation and transection of the same. Dissection of the tonsil from cranial to caudal and caudal removal. Creation of a mucosal plasty. Hemostasis using H2O2 swabs and bipolar. Move on to the right, slightly smaller tonsil. Identical procedure here. Samples are then taken from the base of the tongue, left, middle and right. These also go to the frozen section. Nasopharyngeal curettage. Another frozen section. Transition to neck dissection on the left side. Here a nevus is seen directly cranial anterior to the scar, DD unclear mass, this is to be removed later. Marking of the skin incision. Injection of 7 ml Ultracaine with added adrenaline. Sterile draping. Skin incision in the area of the old scar and extending caudally-anteriorly. Dissection through the subcutaneous tissue and the platysma. Formation of the platysma skin flap anteriorly and posteriorly. In the cranial area massive scarring in level II/III. Ligation and transection of the external jugular vein and the auricular nerve. Exposure of the front edge of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Cranial after sharp detachment of the sternocleidomastoid muscle Dissection in the direction of the accessorius nerve. Complete skeletonization of the internal jugular vein. Subsequent exposure of the accessorius nerve. Displacement and, at the end of the operation, re-embedding of the accessory nerve in the sense of a neurolysis. The accessory nerve remains intact and functional until the end of the operation, both in the lateral and medial part. Complete skeletonization of the digastric muscle up to its anterior muscle belly. Subsequent removal of regions II to V on the left side, sparing all non-lymphatic structures. The cervical plexus as well as the cervical sinus and vagus nerve are exposed and spared. Finally, the hypoglossal nerve is exposed at its junction with the external carotid artery. Some lymph nodes are then also completely removed from this area in conjunction with any remaining scar tissue. The hypoglossal nerve is morphologically and functionally intact until the end of the operation. Relocation and, at the end of the operation, re-embedding of the vagus nerve and hypoglossal nerve in the sense of a neurolysis. Subsequently, removal of the small mass in the area of the skin incision, which is examined using frozen section histology. The pathological examination reveals a benign nevus. Finally, insertion of a Redon suction drain. Two-layer wound closure. Application of a wound and pressure dressing. Final consultation with the anesthetist. Note: The frozen section showed an in-sano resected pT1 tonsillar carcinoma. Other frozen sections were unremarkable. Further procedure after receipt of the histology and discussion in our tumor conference. Selective revision neck dissection on the left side of regions II to V, sparing all non-lymphatic structures. At the end of the operation, the accessorius and hypoglossal nerves are intact and functional in their entirety.