The patient underwent radiotherapy for a Schmincke carcinoma in the nasopharynx in 1981. In 1983 and 1986 a new radiotherapy with neck dissection was performed on both sides. The patient received a total of over 100 Gy. A second carcinoma now appeared in the area of the oropharynx, starting at the glossoalveolar groove, extending into the base of the tongue and the posterior palatal arch. The external biopsy revealed a G2 squamous cell carcinoma. Clinically, there is a cN2 neck status. In addition, the patient has a complete occlusion of the internal carotid artery on the left side and multiple plaques of the external carotid artery on both sides. The patient underwent left carotid surgery <2015>. Due to the rather superficially growing tumor and due to the previous vascular disease, only the above-mentioned tumor resection was performed and a neck revision was dispensed with and, if possible, a free flap graft was also dispensed with.