First, an introductory consultation with the anesthesia colleagues. This included laryngoscopic placement of the glottic plane and inspection of the trachea, subglottis and main bronchi, which revealed normal mucosal conditions. The surgeon then intubates the patient without any problems. Flexible esophagogastroscopy. The flexible instrument is inserted into the oesophagus without any problems and the patient is visualized as far as the stomach, where a regular folded relief can be seen. Aspiration of the insufflated air. Then mirror back and carefully inspect the esophageal mucosa, which is also non-irritating and inconspicuous. Now reposition the patient and inspect the oral cavity, oropharynx, pharynx and larynx with the size C Kleinsasser tube. Here, too, the mucous membrane is free of irritation and inconspicuous with no evidence of a tumor. Insertion of the TE blocker. Inspection of the tonsil regions on both sides. Palpation of the left tonsil, which is slightly indurated. Start with tonsillectomy of the left side. Mucosal incision close to the uvula and subsequent sharp dissection of the anterior and posterior palatal arch. Then detachment of the tonsil from the upper pole after exposing and severing and coagulation of the pole vessels. Further dissection of the tonsil with the raspatory. Repeated coagulation of smaller vessel inflows. Finally, dissection up to the lower tonsil pole and removal of the tonsil. Subsequent coagulation of the lower pole vessels with a portion of the tongue base tonsil. Then perform a palatal arch plasty and move to the right side. Identical procedure here. The palatal arch plasty was also performed at the end of the operation. The right side was also removed with a portion of the tongue base tonsil. Careful inspection of the tonsils. These are largely unremarkable and are sent separately for histopathological examination. Then insertion of the velo tractio and indirect inspection of the epipharynx. Adenoid tissue is also seen here, no evidence of a tumor. Then curettage of the nasopharynx and this preparation is also sent separately for histopathological examination. Then careful hemostasis is performed. Adjustment of the base of the tongue with the small water tube. This is also visible and palpable. Take biopsies from both sides and the middle. These are also sent for histopathological examination. Then careful hemostasis here too. All instruments are removed and the patient is repositioned for neck dissection on the left side. Injection of local anesthetic with adrenaline. Now start with an incision along the sternocleidomastoid. Dissection in layers in depth. Cut through the platysma. Ligation of the external jugular vein. Further exposure and dissection in depth. Here, search for the cervical vascular sheath. This is then dissected over a long distance. Exposure of the vagus nerve, which is displaced medially and re-embedded here in the sense of a neurolysis. Severe scarring in the area of the venous angle and a lymph node conglomerate can be seen. Extremely careful dissection here. The conglomerate is also firmly attached to the hypoglossal triangle. Here the hypoglossal nerve is located via the cervical profunda. Long-distance dissection of the nerve of both the cervical profunda and the hypoglossal nerve. The hypoglossal nerve is dissected free from its bed and displaced cranially. Lateral to the cervical vascular sheath, the accessorius nerve is then accessed. Long-distance nerve preparation here too. Perform neurolysis and re-embedding of the nerve. Finally, removal of the entire hypoglossal triangle and the lateral neck preparation. Dissection of the neck preparation ventral to the cervical vascular sheath. All venous and arterial vessels are preserved here. At the end of the dissection, a neck dissection of level Ib, II, III, IV results. At the end, careful hemostasis and irrigation of the wound. Insertion of a Redon drainage and two-layer wound closure. Then application of a pressure bandage and completion of the procedure. Final consultation with anesthesia colleagues. Further procedure depending on the findings of the histological tissue examinations.