First, after significantly more difficult intubation by the anesthesia colleagues, a pharyngoscopy/laryngoscopy was performed with the small bore tube. The tumor described above was found to be markedly exophytic in the area of the left aryepiglottic fold. Here it overhangs the glottis. The glottis itself is virtually invisible. Now for delimitation, especially inspection of the hypopharynx. Here the posterior wall is exposed. There is an infiltration of the anterior piriform sinus wall, otherwise free piriform sinus on the left side. The opposite side is completely tumor-free. The esophageal inlet is now exposed. This is also free. The postcricoid region cannot be adequately assessed. The lingual epiglottis as well as the vallecula and the base of the tongue are also completely tumor-free. The PEG is now inserted. To do this, enter with the gastroscope. Easy to see through to the stomach. If the diaphanoscopy is excellent, puncture the stomach without any problems and perform the PEG insertion using the usual suture pull-through method. Then repositioning. After insertion of a nasogastric tube, careful injection of xylocaine with added adrenaline. Make a skin incision on the left as for neck dissection. If the larynx is very low, make a caudal incision up to the edge of the tracheostoma to be inserted. To the right, make a skin incision adjacent to the former carotid scar, resulting in an incomplete apron flap. Cut through skin and subcutaneous tissue. Creation of a platysmal flap. Ligation of the anterior jugular vein. Formation of the apron flap to well above hyoid level. Strikingly pronounced superficial venous network. Some veins are ligated and ligated here. Preservation of the external jugular vein. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the hyoid. Exposure of the submandibular gland and inclusion of the caudal part of the capsule. Exposure of the digastric muscle. Release of the anterior neck preparation while exposing and preserving the superior thyroid artery. The cervical artery is also removed. Now expose the accessorius nerve. Exposure of the internal jugular vein. Exposure and preservation of the facial vein and careful clearing of the accessorius triangle. Clearing of level V with careful protection of the cervical branches and without evidence of lymph flow. Also extensive venous network here. Ligation of a strong venous branch, otherwise dry conditions after inspection. Finally, clearing of level VI and completion of the neck dissection. Overall, clinically no metastases or suspicious lymph nodes. Another careful inspection of the wound area. Now turn to tumor resection: Exposure of the hyoid. Dissection of the infrahyoid musculature. Dissection of the thyroid pole. Skeletonization of the larynx and hyoid. Dissection of the perichondrium in the area of the right larynx. Dissection of the infrahyoid musculature. Skeletonization of the larynx and dissection of the thyroid gland. Exposure of the cricoid cartilage and the anterior surface of the trachea with preparation for tracheotomy. Now perform the pharyngotomy. This is done just below the hyoid with the vallecula free. Enter the vallecula on the right side. Widen the pharyngotomy. Snaring of the epiglottis. Mobilization by resection. Opening in the direction of the right aryepiglottic fold. The exophytic tumor is now visible, especially in the area of the right aryepiglottic fold. Approx. 2/3 of the left laryngeal epiglottis is affected by the tumor. Growth via the left aryepiglottic fold into the left piriform sinus. Here, as in the endoscopy, infiltration of the anterior wall. Good mobilization in otherwise clear conditions. Visualization of the postcricoid region. This is completely free. Likewise, no growth towards the esophagus. The tumor grows over the aryepiglottic fold on the left onto the left ary and here into the posterior commissure. Tracheotomy is now performed. Transfer intubation to an LE tube. Resection of the tumor with a safety margin of approx. 1 to 1.5 cm on all sides. No deep infiltration. Final macroscopic resection here. Nevertheless, the epiglottis was dissected. Initially a narrow incision. Therefore, suture the epiglottis on the specimen and send the specimen for definitive histology. Marginal samples are now taken from the entire area from the base of the tongue to the lateral pharyngeal wall, covering the postcricoid region, and marked with sutures. These are found to be free of carcinoma on all sides. Mild to moderate dysplasia in the area of the base of the tongue and the postcricoid region in the frozen section cannot be ruled out. With macroscopic in sano resection and no evidence of higher grade dysplasia, no resection is necessary. Finally, there is sufficient pharyngeal mucosa so that a primary reconstruction with local mucosa can be performed. Now insertion of a Provox voice prosthesis. Insertion with the esophageal troicart. Problem-free tracheoesophageal puncture. Problem-free insertion of the Provox prosthesis size 1.8 mm. Problem-free placement just below the future upper edge of the tracheostoma. Good fit. Insertion of the tracheostoma. Caudal pharyngeal suture submucosally with 3.0 Vicryl meticulously with inversion of mucosal bulging in the area of the caudal pharyngeal tube and the base of the tongue. Overall strong, holding pharyngeal tube on all sides with good suture conditions. After complete suturing, countersink the suture with a second pharyngeal muscle suture. Now caudally over-suture the pharyngeal tube with thyroid gland. Suture the infrahyoid muscles to the skeletonized hyoid and over the pharyngeal suture. Extensive wound irrigation and inspection of all wound cavities and, in dry conditions, insertion of two 10-gauge Redon drains and careful two-layer wound closure and residual suturing of the tracheostoma. Finally, problem-free reintubation to a 10 mm tracheoflex cannula and application of a wound dressing. The procedure was completed without any complications. Conclusion: Intraoperative R0-resected, extensive cT3 cN0 G2 supraglottic laryngeal carcinoma on the left side. Due to the previous carotid surgery, neck dissection of the right side was deliberately avoided. An X-ray vomit was performed on the 8th postoperative day. The nasogastric tube can be removed on the 3rd postoperative day. Please check coagulation carefully postoperatively due to the need for full heparinization. Leave the Redon drains in place for at least 2 days postoperatively. The patient received intraoperative single-shot antibiotics of Clindamycin 600 mg.