After active patient identification, the patient is brought into the operating theater. Carry out the team time-out. Introductory consultation with the anesthesia department. Induction of anesthesia and intubation of the patient. Start of tonsillectomy. Insertion of the McIvor oral spatula while protecting the teeth, lips and tongue. Grasping the tonsil and medializing it. Mucosal incision in the area of the fold at the anterior palatal arch. Exposure of the tonsil capsule. Successive dissection along the muscles of the anterior and posterior palatal arch. Exposure of the lower tonsil pole. Bipolar coagulation of the pole vessels. Separation of the tonsil at the lower left pole. This is sent in for frozen section diagnostics. Perform a mucosoplasty. In the meantime, reposition the patient for neck dissection on the left side. Superficial skin disinfection. Infiltration anesthesia. Ablation of the surgical site and sterile draping. Marking of the planned incision from the mastoid over the front edge of the sternocleidomastoid muscle, curving caudally. Cut sharply through the cutis and subcutis as well as the platysma. Exposure of the anterior edge of the sternocleidomastoid muscle. Exposure of the omohyoid muscle as the caudal border. Exposure, displacement, neurolysis and re-embedding of the accessorius nerve and the posterior digastric nerve as the cranial border. Turning to the cervical vascular sheath and exposure of the internal jugular vein and the common carotid artery. Successive detachment of the pronounced metastatic conglomerate from the sternocleidomastoid muscle. A clear displacement layer is visible here, so that intraoperatively no infiltration of the muscle must be assumed. In region II, the jugular vein is adjacent to the metastatic conglomerate. After laborious blunt dissection, however, it can be seen that a displacement layer is also present here. The vein therefore does not appear to be infiltrated by tumor even in the cranial sections. Therefore, successive sharp and blunt dissection and detachment of the metastatic conglomerate from the internal jugular vein. Subsequent successive development of the neck preparation from level IIb via level IIa, III and IV. Palpation reveals further metastases in the deep level IV as well as in level V. Level IV and V are therefore also cleared. A prominent thoracic duct can also be seen in deep level IV. This is grasped and ligated several times. Subsequent hemostasis using bipolar coagulation. There is no chyle flow here. Then develop the medial neck preparation. The superior thyroid artery must be ligated in advance, as there is a strong outflow in the direction of the tumor conglomerate. Finally, palpatory exploration of the wound cavity. There is no evidence of further metastatic nodes. Hemostasis using bipolar coagulation. Wound irrigation with H2O2 and Ringer's solution. Insertion of a 10-gauge Redon drain. Two-layer wound closure with Vicryl 4.0 and Ethilon 5.0. Application of a pressure bandage. In the meantime, a rapid incision was made by telephone, stating that a tonsil carcinoma R0 was resected on the left side as part of the tumor tonsillectomy. A resection is therefore necessary. Final inspection of the tonsil lobe. If the wound bed is dry, the operation is completed without complications. Final consultation with the anesthetist.