Oesophagoscopy and PEG insertion: Easy entry into the stomach with the oesophagoscope. Inconspicuous mucosal conditions can be seen here. Inversion without any problems. After safe diaphanoscopy, PEG placement is performed in the typical manner using the thread pull-through method. Pharyngoscopy and laryngoscopy: The well-known tumor measuring approx. 2 x 3 cm can be seen in the area of the tonsil on the left side. On the right side in the area of the uvula as well as the posterior pharyngeal wall, the piriform sinus on both sides, the esophageal entrance and the entire endolarynx, the mucosal conditions are unremarkable. No evidence of exophytic tumor growth. Enoral tumor resection: insertion of the Mc Ivor blade. Establish the resection margins with sufficient safety distance using the electric needle. Successive release of the tumor under visual control. Careful hemostasis with the bipolar. The resection covers the entire tonsil on the left side and extends into the base of the tongue and onto the posterior pharyngeal wall. The preparation is then marked with a suture and sent for a frozen section. Insertion of two hydrogen compresses and repositioning for neck dissection on the right side. Skin disinfection and local anesthesia. Approx. 15 cm long curved skin incision in the area of the front edge of the sternocleidomastoid muscle. Separation of the subcutaneous tissue. Separation of the platysma. Exposure of the anterior edge of the sternocleidomastoid muscle. Dissection of the medial part of the muscle. Exposure of the digastricus venter posterior muscle and the omohyoid muscle. Then expose the accessorius nerve and the internal jugular vein. The internal jugular vein is now successively exposed. Then explore the anterior galenic muscle in the caudal region. Now successively dissect the neck preparation caudally with careful bipolar coagulation. Then dissect and clear the accessorius triangle. Release the lateral neck preparation from cranial to caudal while protecting the plexus branches. Then careful hemostasis with the bipolar. Now dissect the facial vein and the submandibular gland. Then evacuation of the venous angle with exposure of the hypoglossal nerve. The capsule of the submandibular gland is also removed in the caudal part. Finally, the caudal part of the medial neck preparation is removed. This allows the cervical anus to be spared. Then rinse with hydrogen and Ringer's solution. Careful hemostasis. Insertion of a 10 mm Redon drain. Cutaneous suture. Skin suture. After obtaining the frozen section, the patient is repositioned again. The frozen section shows a carcinoma in situ in the area of the median margin. The decision is therefore made to resect. The electric needle is now used to carefully resect again. Subsequent careful hemostasis. Insertion of two hydrogen swabs. The specimen is sent for final histology. Finally, no cervical structures are exposed in the area of the oral cavity. Now repositioning for neck dissection on the left side: skin disinfection. Local anesthesia. Renewed, approx. 15 cm long curved skin incision in the area of the front edge of the sternocleidomastoid muscle. Cut through the subcutaneous tissue and the platysma. Exposure of the anterior edge of the sternocleidomastoid muscle and exposure of the muscle in its median portion. Exposure of the omohyoid muscle and the posterior digastric muscle. An extensive, firmly attached lymph node bundle is now visible in the area of level II, which appears to be directly adjacent to the accessorius nerve and the internal jugular vein. The accessorius nerve is shown in its caudal course. The internal jugular vein is also dissected in its caudal course. The anterior scalene muscle is now explored in the caudal region. The internal jugular vein is now dissected from caudal to cranial. The neck preparation is then placed in the caudal region. This is done with careful bipolar coagulation. The thoracic duct is not exposed. The facial vein is then exposed in the cranial region and the venous angle is dissected. The hypoglossal nerve is successfully exposed. Then, with great difficulty, the lymph node conglomerate is detached from the internal jugular vein and the venous angle is dissected. The accessorius nerve is now dissected further cranially. This results in the opening of an apparently necrotic, disintegrating lymph node. The escaping fluid is suctioned out with the aspirator. The lymph node conglomerate is then removed while sparing the accessorius nerve. Now there is a much better overview. The entire course of the accessory nerve can now be visualized. The accessorius triangle is then evacuated. This is done with careful hemostasis. Further suspicious lymph nodes are also clinically present here. These are now successively removed. Expose the internal jugular vein in its entire course from caudal to cranial. Subsequently, successive dissection of the lateral neck preparation and removal of the same with careful hemostasis. Due to the adhesions in the cranial area, some smaller branches of the cervical plexus are also resected. The cervical plexus itself can be preserved. The caudal medial neck preparation is then removed while sparing the cervical nerve. In addition, removal of the caudal part of the capsule of the submandibular gland. Careful hemostasis and irrigation with hydrogen and Ringer's solution. Insertion of a 10-gauge Redon drain. Subcutaneous suture. Skin suture. Now reposition again for endoral inspection: the inserted hydrogen swabs are now removed. Careful hemostasis again with the bipolar. The operation is then completed without bleeding or complications. Conclusion: Enormous tumor resection of a T2 tonsillar carcinoma on the left. First CIS in the median part in the frozen section, therefore decision to resect. Problem-free PEG placement. Neck dissection on both sides, levels 1b to 5, with clinically suspicious lymph nodes on the left side in levels 1b, 2 and 3.