First induction of anesthesia and frustrating bronchoscopic intubation by anesthesia colleagues. Positioning of the patient by the surgeon and performance of a rigid laryngoscopy using Kleinsasser-C. In the area of the anterior commissure, to the left paramedian side, an exophytic, contact-vulnerable, blood-stained mass was found, corresponding to the histologically confirmed G2 squamous cell carcinoma. There was a spread towards the anterior pocket fold on the left, the anterior right vocal fold was already affected by the tumorous mass. Thus classification rcT2. After removal of the Kleinsasser C-tube, repositioning of the patient. Injection of local anesthesia in the old surgical scar on the thyroid cartilage cavity. Skin spray disinfection, abjoration of the skin and sterile draping. Make a skin incision in the area of the old surgical scar approx. 4 cm through the subcutaneous tissue, expose and cut the prelarygeal muscles in the midline area. Push the prelaryngeal muscles to the side on both sides. Exposure of the thyroid cartilage. Closure of the perichondrium in the midline, pushing the perichondrium out of the anterior surface of the thyroid cartilage. Formation of a perichondrium flap. Performing a paramedian thyrotomy using a wire. Exposure of the inner perichondrium leaf and subperichondral dissection along the inner surface of the thyroid cartilage. Slit the endolaryngeal mucosa, initially cranially, thus entering the laryngeal lumen and inspecting the tumor from the cranial side. Successive incision of the endolaryngeal mucosa caudally and successive bypassing of the tumorous mass at the anterior commissure, including the anterior parts of the right vocal fold and the anterior 2/3 of the left vocal fold. The specimen is sent in for final histology marked with a thread (short short anterior commissure, short long supraglottic, long long subglottic). A post-resection in the supraglottic region is sent in thread-marked (short short posterior commissure, short long superior) and a third post-resection on the right vocal fold is sent in for final histology. Four marginal samples were taken (right vocal fold lower, right vocal fold upper, supraglottic posterior left and left vocal fold posterior). Intraoperative frozen section examination revealed mild to moderate dysplasia in the left posterior vocal fold margin specimen, otherwise all margin specimens were free of carcinoma. Hemostasis using pointed swabs soaked in hydrogen peroxide. Hemostasis using bipolar coagulation, suture adaptation of the supraglottic soft tissues on the severed thyroid cartilage leaves using Vicryl 2-0. Adaptation of both thyroid cartilage leaves using Vicryl 2-0. Drill holes created on both thyroid cartilage leaves using a Lindemann burr and fixation of a size 16 Keel foil at glottic level. Adaptation of the perichondrium flap to the outer surface of the thyroid cartilage. Readaptation of the prelaryngeal musculature in the midline. Creation of a flap. Two-layer wound closure, pressure dressing and subsequent performance of a plastic tracheotomy. Creation of an approx. 3 cm long incision along the old scar at the level of the lower edge of the cricoid cartilage. Entering the scarred tissue, hemostasis by bipolar coagulation. Exposure of the anterior tracheal wall, creation of an incision between the 2nd and 3rd tracheal cartilage clasp. Creation of a Björk flap and creation of tracheostomy sutures. Reintubation and insertion of an 8 mm Rügheimer cannula. Completion of the procedure without complications. The patient received intraoperative SDH 250 mg intravenously and clindamycin 600 mg intravenously. Please continue antibiotics for one week.