First panendoscopy: Tracheoscopy as part of intubation with normal endolaryngeal and tracheal findings. Subsequently, endoscopic support laryngoscopy with unremarkable mucosal conditions in the area of the oral cavity. However, in the area of the right oropharynx, the tumor described above was found, starting from the lower tonsil pole on the right, subtotally occupying the lateral pharyngeal wall on the right up to the level immediately above the hyoid bone and with adjacent infiltration of the right base of the tongue. The piriform recess is without macroscopic tumor involvement on both sides. The final esophagogastroscopy also revealed no evidence of mucosal lesions or masses. A PEG tube is then inserted. For this purpose, diaphanoscopy and insertion of the PEG cannula under endoscopic view after detection of a cellular elevation of the gastric mucosa. The PEG tube is then inserted retrogradely using the Sellinger technique from the peroral side and fixed to the abdominal wall with appropriate traction. Sterile wound dressing. A tracheostoma is then created. For this purpose, a skin incision is made pretracheally below the cricoid cartilage. Dissection of the subcutaneous tissue and blunt dissection in the area of the linea alba of the prelaryngeal musculature. Locate the thyroid isthmus and cut through it. A tracheal flap is now placed caudally between the 2nd and 3rd cricoid cartilage and sutured to the lower edge of the stoma. The cranial skin edge is also fixed to the trachea and the lateral skin to each other. Re-intubation. Neck dissection is performed first on the right side. To do this, make a skin incision along the sternocleidomastoid muscle, extending caudally and laterally, to improve postoperative lymphatic drainage. Then expose the anterior edge of the sternocleidomastoid muscle after creating a cranial platysmal flap. Dissection down to the vascular nerve sheath. Then dissection along the omohyoid muscle up to the hyoid bone. Now expose the lower edge of the submandibular gland and complete the neck block II/III cranially along the posterior digastric venter muscle. This shows an extensive, approx. 4 cm large metastasis in the area of region II, which is directly adjacent to the accessorius nerve, the internal jugular vein and the hypoglossal nerve, but does not infiltrate these structures. This allows the metastasis, whose capsule appears macroscopically intact, to be carefully dissected free of the structures. Dissection is considerably more difficult due to the growth of the metastasis in the direction of the jugular foramen. Further dissection of the vascular nerve sheath and completion of regions II, III and IV. This is followed by dissection of region V. Dissection down to the trapezius muscle in the cranial region Va while sparing the accessorius nerve. Dissection cranially down to the muscle, and in the caudal region the cervical plexus forms the deep boundary. After complete evacuation of region V (individual smaller lymph nodes can still be detected macroscopically here), the lateral pharyngotomy is performed immediately below the right hyoid bone in accordance with the previous endoscopy. After opening the pharynx, the spherical tumor, which is pedicled approx. 1 1/2 cm above the entrance, shows infiltrative growth in the area of the lower tonsil lobe on the right and the soft tissues of the neck there as well as in the base of the tongue. The tumor is now carefully dissected accordingly. A safety margin of at least 1 cm is maintained macroscopically. Complete the cranial resection from the enoral side using a tongue retractor and detach the tonsil in the right upper pole area caudally up to the transition to the base of the tongue. Final completion of the tumor resection via the lateral pharyngotomy approach. This procedure ensures the best possible view for the tumor resection. The resulting mucosal defect in the area of the lateral wall of the oropharynx and the base of the tongue on the right side is such that primary wound closure appears feasible and sensible. The pharyngeal wall is sutured on the right side, which is done in several layers by suturing the mucosa and the underlying pharyngeal and throat muscles. The wound surface of the base of the tongue and the tonsil lobe remain free. To prevent bleeding due to the deep wound surface, particularly in the area of the base of the tongue, the lingual artery is then ligated at its exit from the external carotid artery. Before the wound was closed, frozen sections were sent in in the area of the edges of the lingual artery and classified by telephone as tumor-free. While waiting for the frozen section result, the neck dissection was performed on the left side. Here, the skin incision is also made in the area of the sternocleidomastoid anterior edge, also extending latero-caudally and dissection of the sternocleidomastoid anterior edge down to the vascular nerve sheath. Now dissect along the omohyoid muscle to the hyoid bone and along the posterior digastric venter muscle to the base of the skull. In the region of regions II, III and IV, there are isolated slightly enlarged lymph nodes, which, however, do not appear suspicious macroscopically. Finally, clear out region V while protecting the accessorius nerve. Dissection down to the trapezius muscle and in the lower section to the cervical plexus. After careful hemostasis, insertion of a 10-gauge Redon drain. Platysma suture, subcutaneous sutures and single-button skin suture. Same procedure on the right side. A light pressure bandage is applied for the first 2 days to protect the pharyngeal suture.  