After positioning the patient, initial inspection of the primary tumor region. There is a superficial ulcerated tumor in the area of the right tonsillar lobe with transition over the glossotonsillar groove into the base of the tongue. On palpation, however, there is also clear submucosal tumor growth with at least 1 cm deep infiltration. In addition, tumor extension into the upper pole of the tonsil and here extending to the palatal arches. The tumor is now resected transorally with a safety margin of a good 1 cm. Inclusion of the anterior palatal arch. Resection of the tumor in the area of the tonsil in the sense of a tumor tonsillectomy. Some scarring in the area of the posterior palatal arch. Good lateral control. Submucosal tumor extension caudally, therefore widening and resection of the pharyngeal side wall into the hypopharyngeal region up to approx. 1 cm below the level of the epiglottis. Resection of the glossotonsillar groove and circumscribed resection of the base of the tongue on the right. The specimen is now thread-marked for frozen section diagnostics. This shows tumor extensions up to the posterior palatal arch with otherwise in sano resection. Basally, there is also an in sano resection, but with a safety margin of 2 to 3 mm in the narrowest area. This has already been identified macroscopically and marked with sutures. Therefore, the final margin sample is now taken in the area of the basal wound bed, primarily to extend the safety margin in the case of a histologically in sano resection. This is followed by a generous resection in the area of the entire posterior palatal arch and a new covering margin sampling. This is later diagnosed as tumor- and dysplasia-free in frozen section diagnostics. Due to the now extensive wound area, a protective tracheotomy is later performed. First repositioning for neck dissection of the right side. Incision along a skin fold. Cut through skin and subcutaneous tissue. Exposure and dissection of the platysma. Dissection of the platysma. Exposure and dissection of the external jugular vein with transverse course. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland and digastric muscle. Removal of the anterior neck preparation with careful protection of the cervical artery, the superior thyroid artery and the hypoglossal nerve. The extremely slender facial vein is removed. Dissection of the internal jugular vein. Cranial dissection and removal of level V with careful protection of the cervical plexus branches. Exposure of the accessorius nerve and completion of the neck dissection after exposure of the common carotid artery and vagus nerve while sparing all the structures mentioned. Macroscopically no necessarily suspicious nodes. Finally, wound inspection and wound irrigation and, if the wound is dry, insertion of a 10 Redon drain and careful, two-layer wound closure. The tracheostomy is then performed. Skin incision below the cricoid cartilage. Cut through skin and subcutaneous tissue. Exposure and sparing dissection of the infrahyoid musculature. Exposure of the cricoid cartilage. Exposure of the anterior surface of the trachea. Insertion between the 1st and 2nd tracheal ring. Creation of a broad-based pedunculated Björk flap. Incision of the tracheostoma. Subsequent problem-free transfer to a size 8 low-cuff cannula, followed by final enoral wound inspection and, if the wound was dry, completion of the procedure without any indication of complications. Conclusion: Intraoperative R0-resected, at least cT2 oropharyngeal carcinoma on the right. Leave the cannula in place until postoperative day 5, after which direct decannulation can be performed if necessary if the wound is healing properly. Postoperative oral diet according to tonsillectomy scheme possible. The patient received intraoperative single shot antibiotics with Unacid 3 g.