Induction of anesthesia and intubation by the anesthetist. Then insertion of the mouth retractor and inspection of the tumor region. An exophytic tumor is found on the right tonsil with transition to the anterior palatal arch. First mark the edges of the incision with the monopolar needle, then incise the mucosa on the anterior palatal arch with the monopolar needle. Continue the incision with the scissors and bipolar forceps, initially on the anterior palatal arch. Then release the tumor preparation at the upper pole. Then dissection at the base of the wound with spreading of the muscles and bipolar coagulation using the dissection technique. Release at the posterior palatal arch. Continue this dissection up to the lower tonsil pole, taking a small piece of the base of the tongue with you to ensure a safety margin. Hemostasis using bipolar coagulation and insertion of hydrogen compresses. Suture marking of the tumor specimen and sending for frozen section. Unfortunately, carcinoma in situ with tumor infiltration is still found on the anterior palatal arch in the frozen section, so a resection is taken from there and a marginal sample is sent to the frozen section again. No more tumor infiltrates can be found in the frozen section. In addition, a marginal sample was taken at the base of the wound, as the resection there was probably very close in sano, to ensure that R0 was also present at this site. This was also confirmed by the pathologist. Ultimately, after frozen section, R0 resection. Transition to neck dissection. Skin incision in the usual manner at the anterior edge of the sternocleidomastoid. Separation of the platysma. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland. Finding and exposing the accessorius nerve. Then free dissection of the internal jugular vein. In the venous angle between the internal jugular vein and the facial nerve, a very large metastasis with spread to level II b is found, which is initially removed. Then removal of the entire level II b. There are further tumor-specific lymph nodes in level II b, all of which are systematically dissected out. Exposure of the cervical vascular sheath and removal of levels III, IV and V while sparing the plexus branches. Smaller lymph nodes are still present everywhere, but they do not look suspicious. Then evacuation of the upper neck block level II a and III while sparing the ansa, the superior thyroid and the hypoglossal nerve. Insertion of a Redon drain and two-layer wound closure. At the end, check again for bleeding - dry conditions. Please present the patient to the tumor conference after receiving the final histology to plan the further procedure.