Initially extended tonsillectomy: Tumor is located at the upper pole of the tonsil, slightly exceeding it cranially. Tumor is incised on all sides with a safety margin of more than 1 cm and removed. Goes to pathology marked with a suture. In addition, a marginal sample from the soft tissues is also sent to the frozen section as a craniobasal marginal sample. Here in the frozen section all specimens are healthy. Thus R0 resection. Repositioning for neck dissection on both sides: skin disinfection, draping. Start with the right side: skin incision in typical manner. Exposure of sternocleidomastoid muscle, exposure of omohyoid muscle and digastric muscle. Large cranial metastasis. Exposure of the cervical vascular sheath, internal and external carotid artery, internal jugular vein and vagus nerve as well as the accessorius and hypoglossal nerves. Subsequent development of the dorsal neck preparation. Knots can be detached from all structures, sometimes with some difficulty. Development of the dorsal neck preparation ........................., clearing also level V a and b. Subsequent development of the anterior neck preparation with visualization and preservation of the superior thyroid artery and hypoglossal nerve. Here now also revision level I b. Here, some lymph nodes in front of and behind the submandibular gland, including its capsule, are also removed. This ultimately results in partial level I and II to V removal. Neck dissection on the left: This is performed in the same way as on the right side, exposing the structures described. Levels II to IV are removed here in a typical manner. Significantly enlarged cranial lymph nodes are also seen here. Then hemostasis and irrigation with H2O2 and Ringer's solution and layered wound closure and insertion of a Redon drain. Subsequent PEG insertion: This is performed with <CLINICIAN_NAME>. Advance the flexible esophagoscope into the stomach. No abnormalities on rough examination. A 9 mm abdominal wall probe is inserted in the typical manner. Then fixation to the abdominal wall. Now an enoral check: the site is unremarkable after an extended tonsillectomy without bleeding. This ends the procedure. Patient receives Sobelin 600 mg i.v. as a single shot.