Enoral tumor resection dictation <CLINICIAN_NAME>. Positioning of the patient for pharyngoscopy and transoral resection. During oral cavity inspection and pharyngoscopy, the tumor is seen in the area of the anterior palatal arch transition to the wire palate, through smaller extensions growth over the glossoalveolar groove to the cheek. Tumor also occupies the anterior palatal arch and tonsil region, growing forward to the floor of the mouth and the base of the tongue. Growth also towards the lower jaw. In the premolar region, growth also extends to the alveolar region, with marked thickening and suspected tumor infiltration. Transoral resection is now performed: insertion of mouth blocks. Application of a tongue tie suture. Exposure of the tumor. Incision of the tumor with a safety margin of at least 1.5 cm to all macroscopically visible tumor margins. The anterior palatal arch and tonsil, tissue of the anterior palatal arch transition to the hard palate, which is exposed in bone. To the side, pterygoid muscles and buccal mucosa are removed. To the depth in the cranial region, removal of the deeper parts of the pterygoid muscles, removal of soft cheek parts up to the lower jaw, removal of the periosteum from the lower jaw. For better assessment, one remaining molar, one premolar and the canine must be extracted. When the periosteum is pushed over the alveolar space, tumor infiltration into the alveoli can be seen. The resection extends forward to the floor of the mouth, the lingual nerve cannot be preserved and is resected together with glandular tissue and muscle tissue. A small part of the base of the tongue is also resected. The specimen is marked in multiples and sent for frozen section histology. In addition, a marginal sample is taken from the front of the cheek via the alveolar ridge to the floor of the mouth at the edge of the tongue for frozen sectioning, also marked with sutures. In the frozen section, all tumor margins on the specimen are clear, except in the area of the transition from the alveolar ridge to the floor of the mouth, where there are small focal CIS infiltrates. Also tumor infiltrates in the soft tissues, in the floor of the mouth below the mucosa. A broad resection of the mucosa is therefore performed from the cheek area over the alveolar ridge in front to the floor of the mouth and extending to the edge of the tongue. In addition, a marginal sample is taken from the same area, which is thread-marked and sent to the frozen section. Also resection of the soft tissue at the floor of the mouth, removal of parts of the submandibular gland, floor of the mouth muscles, removal of the wharton duct, resection extends to the sublingual gland. Prior to this, further removal of soft tissue as a marginal sample, consisting of glandular tissue, muscles and periosteum on the lower jaw. Both marginal samples are now tumor-free, so that the resection of the tumor is healthy with regard to the soft tissue situation. In this case, the soft tissue situation is the same as the R0 situation. As part of the marginal sampling, a marginal sample was also taken from the alveolus in the premolar region, where areas of suspected tumor were found. Here, the tumor infiltrated the bone through the alveoli. Thus, a complete infiltration of the bone into the medulla can be assumed. To complete the tumor resection, a mandibular resection is required here, with replacement by fibula or scapula graft. Completion of the resection at this point. PEG placement and tracheotomy are performed, which is dictated by <CLINICIAN_NAME>. After enoral tumor resection, meticulous hemostasis. Subsequent insertion of the flexible gastroesophagoscope and easy advancement under air insufflation into the stomach. A clearly reddened esophagus with whitish mucosal deposits is already visible about 25 cm from the dentate line, with only sections of inconspicuous mucosa up to the cardia area. The gastroesophageal junction shows about 5 cm cranially extending, bleeding lesions of the folded ridges, reflux-associated DD Barrett's esophagus, DD (Winson's syndrome). In this case, a gastroenterological check-up with sampling is absolutely necessary in the further course. Air insufflation in the stomach, clearly positive diaphanoscopy and placement of a PEG tube using the thread pull-through method without any problems. The patient was then repositioned, abjoded and draped. Marking the incision for the tracheostomy. Cutaneous incision, subcutaneous preparation, longitudinal division of the linea alba. Exposure of the thyroid isthmus at its upper and lower edge, undermining of the same. Clamping of the isthmus on both sides. Sharp transection and repositioning of both isthmus edges. Incision between 2nd and 3rd tracheal cartilage. Application of a Björk flap inferiorly on both sides, fixation of the tracheostoma using 4 holding sutures cranially and caudally, a tension-reducing cutaneous suture on both sides and an additional lateral cutaneous suture on the left. Subsequent problem-free reintubation and ventilation via the cannula. The procedure was completed without complications. Please contact the oral surgery colleagues immediately to complete the operation and cover the defect with a periosteal graft. This should cover parts of the floor of the mouth and the bony structures in the upper jaw. It is not absolutely necessary to cover the area of the palatal arch, as the posterior palatal arch is preserved here. Aim for early transfer of the patient to the maxillofacial surgery department. Please continue the antibiotic treatment that was started intraoperatively with Unacid.