At the beginning, after induction of anesthesia and intubation by the anesthesia colleagues, the first step was to enter with the small bore tube under dental protection after inspection of the inconspicuous oral vestibule. As described above, the exophytic, solid mass of the vallecula is now visible, slightly accentuated on the right. Circumscribed transition to the base of the tongue, which, however, is not further infiltrated by palpation and inspection. Tumor extension to the lingual epiglottis with clear infiltration or non-displacement of the tumor towards the epiglottis. Overall, the extension of a cT2 finding can be confirmed here. In conjunction with the CT imaging with contact to the hyoid, as already indicated, proceed transcervically. Position the patient for this. Injection of xylocaine with added adrenaline. Submandibular skin incision with extension to the apron flap. Cut through skin and subcutaneous tissue. Exposure and dissection of the platysma. Dissection of the apron flap with high suture. Caudal dissection of the platysma. Dissection of both sides of the sternocleidomastoid muscle and the omohyoid muscle. Exposure of both sides of the submandibular gland and the digastric muscle on both sides and preservation of the facial vein. Exposure of the hyoid. Exposure of the infrahyoid muscles. Due to the cranial location of the tumor, the hyoid is skeletonized first, but the thyrohyoid connections and muscles are left completely intact. On the left side, above the hyoid, enter the pharynx. Perform the pharyngotomy approx. 1 cm lateral to the tumor and thus safely in sano. The tumor is now successively exposed. Resection with a small strip of the base of the tongue basally, especially on the right. The tumor extends in depth to the hyoid, but can be clearly separated from the hyoid with a good shifting layer. No signs of infiltration. Nevertheless, the periosteum of the hyoid is completely resected in the support area. If the lingual epiglottis is infiltrated, a subtotal partial resection of the epiglottis is performed. The petiolus and the caudal epiglottis can be left circumscribed. No migration through the epiglottis and no extension to supraglottic structures. Resection of the tumor macroscopically in toto. This is thread-marked for definitive histology. On macroscopic examination of the specimen, only a somewhat narrow margin in the area of the base of the tongue on the right is noticeable. A covering resection is performed here. Finally, the tumor is completely covered with marginal samples, which prove to be completely free of tumor and dysplasia in the frozen section diagnosis. After demonstrating the findings and discussing the case with <CLINICIAN_NAME>, the adaptive, inverting mucosal suture is later applied to reduce the size of the defect. The hyoid suspension at the base of the tongue is then performed using Vicryl sutures of strength 0. This results in significant height gain and elevation of the entire larynx, which, thanks to the intact connection to the hyoid, can be well elevated by the measures described. Finally, completely intact conditions and stable elevation function. In the meantime, the neck was dissected on both sides, initially starting on the right side. After clearing out the anterior neck preparation, while preserving the superior thyroid artery, the cervical artery and the hypoglossal nerve, the internal jugular vein is dissected free. This reveals several coarse and macroscopically highly suspicious nodules measuring up to 3 cm around the jugular-facial angle without signs of infiltration of the surrounding area. These can be completely removed macroscopically in sano. Exposure of the accessorius nerve. Clearing of the accessorius triangle with careful protection of the nerve. Evacuation of level V with careful protection of the cervical plexus branches. Careful inspection and, if the wound is dry, wound irrigation and turning to the opposite side. Now neck dissection on the left. The procedure is basically the same here. During careful inspection, nodules up to a size of 2 cm can be palpated in the area of the jugulo-facial angle. Also remove the anterior neck preparation while preserving the cervical artery, the superior thyroid artery and the hypoglossal nerve. Free preparation of the internal jugular vein. Exposure of the accessorius nerve. Clearing of the accessorius triangle with careful protection of the nerve. Subsequent evacuation of level V with careful protection of the cervical plexus branches and caudal, special check for lymphatic dryness. Final irrigation of all wound areas and, in dry conditions, insertion of a 10 Redon drain on each side and careful, two-layer wound closure. Due to the resection defect and the a priori unclear swallowing function after subtotal epiglottis resection, a plastic tracheotomy is now performed. The tracheotomy is deliberately placed away from the resection area. Skin incision approx. 1 cm below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure of the infrahyoid musculature. Entering the linea alba. Exposure of the anterior surface of the trachea. Exposure of the thyroid isthmus. Dissection of the thyroid isthmus and supply with re-stitching. Exposure of the anterior surface of the trachea. Insertion between the 2nd and 3rd tracheal ring. Placement of a broad-based pedicled Björk flap and insertion of the tracheostoma in the usual manner. Subsequent problem-free transfer to a size 8 low-cuff cannula, followed by repositioning of the patient and completion of the procedure without any indication of complications. Conclusion: Intraoperative R0 resected cT2 cN2c G3 vallecula carcinoma right accentuated. Postoperative feeding via PEG tube for 7 days. Subsequent swallowing attempt and decannulation depending on swallowing function. Due to the localization and extent, with bilateral cervical lymph node metastases in particular, adjuvant therapy is urgently required here.