Now insertion of the tonsil blocker and then start with the tumor resection. The tonsil carcinoma is cut around cranially in the healthy tissue with the electric needle and separated laterally up to the alveolar ridge. The tumor specimen is now developed and removed from the cranial to the caudal side in a plane that is easy to move in the area of the musculature. The lateral base of the tongue is also resected caudally. In between, bipolar hemostasis and removal of the tumor specimen en bloc. In between, the findings were demonstrated intraoperatively on <CLINICIAN_NAME>. The tumor is thread-marked for frozen section. During the operation, it was found that the tumor was still interspersed with carcinoma in situ or severe dysplasia caudally in the area of the base of the tongue and in the area of the anterior palatal arch and the glossotonsillar groove. The decision was therefore made to perform a resection. A large piece of mucosa is resected in the area of the glossotonsillar groove in the anterior palatal arch. This is cut to such an extent that part of the submandibular gland is exposed enorally. A large section of the base of the tongue is resected caudally so that the epiglottis is completely visible on the left side. Now a flat piece from the tonsillar loge is resected in toto again to counter the dysplasia described above in the area of the upper anterior palatal arch and transitioning to the posterior pharyngeal wall. These specimens are also sent to the frozen section marked with a thread. Bipolar blood is then stopped. This frozen section is then only found to be interspersed with dysplasia in the area of the base of the tongue. After consultation with <CLINICIAN_NAME>, a further section is cut here, which is sent for final histological assessment. Bipolar blood is now meticulously stopped and hydrogen swabs are inserted. Transfer for neck dissection on the right: instillation of 10 ml xylocaine with adrenaline in the area of the sternocleidomastoid margin. Skin incision, cutting of the subcutaneous tissue and the platysma. Ligation of the external jugular vein and removal. Expose the anterior border of the sternocleidomastoid, the accessorius nerve, the cervical vascular nerve sheath and the omohyoid muscle. The cervical vascular nerve sheath is now exposed in the sense of the internal jugular vein, common carotid artery and vagus nerve. The posterior neck preparation is then successively removed from the upper accessorius triangle and completely removed while sparing the plexus branches and the accessorius nerve. Nodes suspicious of metastases are noted in level IIb. The anterior neck dissection is then completed by removal of the capsule of the submandibular gland, visualization of the hypoglossal nerve and three operations in the anterior triangle of the neck. Minor bleeding is coagulated. This is followed by hydrogen and ring irrigation, hemostasis and insertion of a Redon drain. The wound is then closed in two layers if the wound is dry. Now repositioning for tracheotomy: modified Kocher collar incision, cutting of the subcutaneous tissue and displacement of the prelaryngeal veins. Now expose the thyroid isthmus and undermine it. Ligature and weaning. Creation of a Björk flap and insertion of the tracheostoma in the usual manner without complications. An 8-bore tracheostoma is inserted. The patient receives 250 mg SDH and 5 mega penicillin i.v. and is admitted to the intensive care unit for monitoring. Finally, a nasogastric feeding tube was inserted. Conclusion: cT3 cN2c tonsillar carcinoma on the left. Neck dissection on the left side should be performed in about 14 days with an extensive enoral wound cavity.