After induction of anesthesia and transnasal intubation by the anesthetist, the oral cavity is first inspected and pharyngoscopy is performed: this reveals an exulcerated region of the posterior edge of the tongue just before the glossotonsillar groove with a clear hardening in the transition from the body of the tongue to the base of the tongue. Thus mouth opening with the ...ratchet and reining of the tongue. Set the resection margins at the glossotonsillar groove, about 1 cm towards the palatal arch, then on the lateral floor of the mouth anteriorly, about 3 cm behind the tip of the tongue and medially almost to the midline. The partial resection of the tongue is now performed successively with the electric needle under bipolar coagulation, taking care to maintain a safe distance from the tumor as far as possible. In the area of the maximum extension of the tumor, the resection reaches the midline of the tongue; further posterior, in the area of the base of the tongue, the resection goes back to the left side. In between, identify and ligate the lingual artery. The submandibular gland is only slightly .... The resection is now completed laterally in the area of the glossotonsillar groove, taking away approx. 1 cm of the lateral pharyngeal wall, whereby it should be noted that the palatal arch and in particular the glossotonsillar groove are clearly scarred due to the previous operations. The main preparation is now sent for frozen section diagnostics. In addition, a resection is performed of the area of scarring, transition from the glossotonsillar groove to the oropharyngeal side wall, as the tissue there appears suspicious. In the main preparation, the frozen section diagnosis identifies an R1 situation in the area of the base of the tongue, mainly at the mucosal level up to approx. 5 mm towards the tongue muscles. CIS is also diagnosed in the area of the glossotonsillar groove transition oropharyngeal side wall. Therefore, a resection is now performed in the area of the base of the tongue from medial to lateral up to the oropharyngeal side wall, which is approximately 1 ˝ cm wide and at least 5 mm thick. In addition, a generous resection is made in the area of the palatal arch transition oropharyngeal side wall, which also extends to the posterior oropharyngeal wall and is also sent for frozen section diagnostics. The tongue base preparation is found to be tumor-free, but a region with carcinoma in situ is also found in the caudal area of the posterior wall of the oropharyngeal side wall transition, now distant from the tumor. As a result, a 3rd resection of the oropharyngeal side wall is now performed, which also clearly extends towards the posterior pharyngeal wall and almost to the entrance of the piriform sinus. This resection is followed by a 3rd marginal sample, which is sent for frozen section diagnostics. This was also found to be a CIS in the frozen section, whereby the colleagues from the pathology department have now established that these CIS sites are not continuous, but are interrupted in different areas. Therefore, there is now a strong suspicion of field carcinomatization. Now consultation and demonstration of findings to <CLINICIAN_NAME>, who advises no further frozen section diagnostics, but instead recommends a final, generous resection, which must then go to final histology. This is now done cranially in the area of the posterior pharyngeal wall and goes caudally almost to the entrance of the piriform sinus and is sent to the final histology with a suture marker. In the meantime, after consultation with <CLINICIAN_NAME>, a tracheotomy was indicated. For this reason, an approx. 2 cm long, horizontal incision was made directly caudal to the cricoid cartilage. Dissection through subcutaneous tissue and platysma. Identification and ligation of the anterior jugular vein. Identify the pretracheal muscles and spread the last one along the linea alba. Identify the thyroid isthmus and undermine the last one. Clamp off with 2 Pean clamps, cut through and reposition with 0 Serafit suture. Now expose the anterior tracheal wall, form a very sparse Björk flap between the 2nd and 3rd tracheal ring, this is secured with 2 tracheostoma threads caudally and 2 cranially and after readaptation of the skin, reintubation is performed on a 7-gauge Rügheimer cannula. A nasogastric feeding tube is also inserted. After re-inspection of the now very large wound area, which affects the anterior tongue almost to the midline, the lateral floor of the mouth and part of the base of the tongue up to approx. 1 cm in front of the vallecula and also extends over part of the palatal arch, the lateral wall of the oropharynx and the posterior pharyngeal wall almost to the midline. Intraoperative administration of 3 g Unacid, which should be continued, and administration of 250 mg SDH. Patient goes to the intensive care unit awake for monitoring. According to <CLINICIAN_NAME>, radial flap coverage may be necessary in the interval.