After appropriate preparation, a plastic tracheostoma is first created in the usual way. Sterile wiping and covering of the patient and injection of supra in the area of the U-shaped incision. Start of the operation by tracheotomy. To do this, make an incision below the cricoid. Cut through the cutaneous and subcutaneous tissue. Exposure of the infralaryngeal musculature and division of the musculature in the midline. Identification of the cricoid cartilage and sharp dissection of the cricoid cartilage. Undermining of the thyroid isthmus and coagulation of the same. After transection of the thyroid isthmus, identification of the anterior tracheal wall and sharp entry into the 2nd to 3rd intertracheal annular gap and creation of a tracheostoma in the usual manner using epithelializing single-button sutures. Insertion of an 8-gauge tracheostomy tube. Subsequent transition to transoral tumor resection. Once the tumor has been positioned, the tumor, which occupies the right tonsil lobe, is resected caudally starting parauvularly macroscopically in healthy musculature using the ultrasonic knife. Laterally, the resection margin extends to the soft tissue of the neck. Caudally, the glossotonsillar groove as well as adjacent parts of the base of the tongue must be included in the resected area. The entire resectate is then sent for a frozen section histological examination for orientation. This reveals narrow resection margins in the area of the tumor base as well as in the area of the base of the tongue. Therefore, a transoral resection from the base of the tumor is performed as far as possible, as well as an extensive resection in the area of the medial base of the tongue. These prove to be free of tumor on frozen section histology. Subsequent transition to neck dissection, initially on the right side. After making the apron flap incision, a radical neck dissection is performed here, as the large metastasis has already infiltrated the internal jugular vein together with the sternocleidomastoid muscle and the accessorius nerve. The vascular nerve sheath is therefore located caudally, the jugular vein is exposed and then cut off and severed. The sternocleidomastoid muscle is also cut caudally. The entire preparation is thus successively developed cranially with resection of parts of the cervical plexus. The hypoglossal nerve as well as the common carotid artery and external carotid artery can be dissected from the metastasis in a healthy layer. The cranial resection also includes the caudal part of the parotid gland. Finally, the internal jugular vein is exposed just below the jugular foramen, dissected free and also removed there. Creation of a Redon suction drainage. Transition to neck dissection on the opposite side. There is no evidence of a suspicious lymph node metastasis. Selective neck dissection is performed in regions II to V, sparing all non-lymphatic structures. Then skeletonize the lingual artery, which will later be used for anastomosis. On the right side, create the passage into the hypopharynx from the lateral side. With a good view of the caudal resection margin, tissue from the adjacent tongue base and the vallecula to the lingual epiglottis is resected again and examined using frozen section histology. This was also found to be R0. In addition, the external carotid artery is freed of all remaining fatty and connective tissue in the oropharyngeal direction in the sense of a further resection from the tumor base; this tissue is also ultimately found to be tumor-free on frozen section histology, so that an overall R0 resection can be assumed. Subsequent removal of a radial lobe graft of the appropriate size by <CLINICIAN_NAME>. Elevation of the radial forearm flap on the left by <CLINICIAN_NAME>: Palpatory identification of the distal radial artery. Marking of the flap borders (6 x 10 cm) on the distal forearm, proximal to the flexor retinaculum, with an S-shaped incision running proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the venous confluence in the cubital fossa. Identification of the cephalic vein and dissection of the vein distally with integration into the radial graft margin. Identification of the ramus externus of the radial nerve and elevation of the radial portion, leaving the peritendineum of the tendons of the brachioradialis muscle intact. Subsequent ulnar incision down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the ulnar edge of the graft up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendons and to spare the ulnar artery. Identification of the distal radial artery and trial clamping with a vascular clamp. After 5 minutes with good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation (Prolene 6.0). Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vessel clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Exposure of the brachial artery, V. mediana cubiti, A. ulnaris. First removal of the radial artery, then of two veins of the superficial venous system. Vascular ligation by means of a bypass ligature (artery) and vascular clip (veins). Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm. Covering of the graft bed with split skin from the right thigh in the usual manner. Suturing of preparation swabs. Application of a wound dressing and a forearm splint. Completion of the graft lift without complications. Subsequent removal of region I with resection of the submandibular gland on the right side after exposing and sparing the ramus marginalis mandibulae. The radial flap is then inserted into the oropharyngeal defect and sutured into the defect starting transorally. The final sutures are placed transcervically from the caudal side. The vascular pedicle is then guided to the opposite side. Here the lingual artery is anastomosed end-to-end with the radial artery. The venous anastomoses are made through 2 veins of the radial flap in an end-to-side manner to the internal jugular vein. Finally, a Redon suction drain and a flap are placed in the left side of the neck in the usual manner. Folding back of the apron flap, completion of the mucocutaneous anastomosis of the tracheostoma and two-layer wound closure in the usual manner. Suturing of the tracheostomy tube after reintubation of the patient and completion of the procedure and transfer of the patient to anesthesia. Placement of the PEG tube: Flexible pre-scanning with the gastroesophagoscope into the stomach. Identification of the anterior wall of the stomach and performance of a positive diaphanoscopy. Insertion of the PEG tube in the usual manner using the thread pull-through method without complications. Careful reflection and termination of the PEG insertion without complications. Conclusion: Combined transoral-transcervical tumor resection of an oropharyngeal carcinoma with extension into the glossotonsillar groove on the right side. Radical neck dissection on the right and selective neck dissection on the left, reconstruction of the oropharyngeal defect on the right with a microvascularly anastomosed radial flap graft from the left forearm, creation of a plastic tracheostoma and a PEG tube, anastomosis of the microvascular radial flap graft on the opposite side to the lingual artery and in an end-to-side manner to the internal jugular vein.