First infiltration anesthesia with xylocaine with adrenaline. A modified apron flap is then created. A modified incision is made in the area of the left neck so that a platysmal flap is also dissected. Dissection through the subcutaneous fatty tissue and the platysma on the right side. Dissection of a platysmal flap on the left side. Successive development of the entire apron flap preparation cranially. Fixation with sutures. Now start with the neck dissection on the right side. Exposure of the sternocleidomastoid anterior margin. Expose the digaster muscle and the omohyoid muscle as muscular borders. Dissection along the internal jugular vein and exposure of the cervical vascular sheath with the carotid artery and the vagus nerve. Sparing of these structures. Exposure and sparing of the accessorius nerve. Now preparation and development of the lateral neck preparation while sparing the plexus branches. Deposition after bipolar coagulation caudally. This works well. Now dissect ventrally along the digastric muscle. The capsule of the submandibular gland is included. Expose and protect the hypoglossal nerve in depth. Dissection of the anterior neck preparation without any problems. Now turn to the left side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and the digaster muscle. Dissection of the internal jugular vein and exposure of the cervical vascular sheath. Sparing of the same. Exposure and sparing of the accessorius nerve. Dissection of the lateral neck preparation while sparing the plexus branches. On the left side there is a lymph node metastasis of approx. 2 cm adherent to the internal jugular vein. However, this metastasis can be bluntly detached from the internal jugular vein. Finally, dissection of the anterior neck preparation, including the capsule of the submandibular gland. Exposure and sparing of the hypgolgossal nerve in depth. Completion of neck dissection on both sides without problems. Attempt partial laryngo/pharyngoectomy according to Lacourreye and laryngectomy as completion. First exposure of the hyoid bone superficially from left to right. Then resection of the hyoid bone and resection of all pre-epiglottic soft tissues, probably on the right side as well as on the left side, leaving the right half of the hyoid bone intact. Dissection up to the pharyngeal tube. Entry into the right paramedian pharyngeal tube. Exposure of the tumor. Cut around the tumor with a safety margin of at least 1 cm in the laryngeal region and up to 1.5 cm in the area of the hypopharyngeal mucosa. Inclusion of the entire epiglottis. Include the thyroid cartilage on the left side up to the level of the cricoid cartilage. Dorsal removal of the largest parts of the aryepiglottic fold, leaving the arytenoid cartilage in the dorsal direction. Parts of the piriform sinus anterior wall must also be resected. The specimen is thread-marked for frozen section. Resection up to this point clearly in healthy tissue and borderline but feasible with regard to meaningful preservation of swallowing function. Very narrow resection margins in the frozen section anteriorly or on the opposite side caudally or posteriorly. A further resection would be associated with a no longer useful functionality of the residual larynx and would increase the risk of aspiration and a permanent tracheostoma. For this reason, further reduction of the residual larynx was avoided and a laryngectomy was now indicated. Extubation of the residual larynx in the typical manner, such as release of the right piriform sinus, detachment of the postcricoid mucosa. Detachment of the piriform constrictor muscle on both sides and the thyroid gland with caudal displacement. The larynx is now removed caudally in the area of the previously placed tracheostomy. The tracheostoma wall remains extended posteriorly in a cranial direction. This is followed by a left myotomy with transection of the fibers of the constrictor pharyngis muscle. This allows much better passage of the finger through the pharyngeal tube. Subsequent insertion of an 8 mm Provox prosthesis in a typical manner without complications. Then closure of the larynx in three layers. First an inverting layer of Vicryl 3.0 single button sutures, followed by a layer of Vicryl 3.0 single button, also inverting. The pharyngeal constrictor muscle is adapted over this to the cranial side. Finally, irrigation of the wound area and layer-by-layer wound closure under a Redon drainage on both sides and epithelialization of the tracheostoma.