After insertion of the oral retractor, marking of the resection margins with monopolar coagulation. The tumor reaches very close to the alveolar ridge on the left side and anteriorly. The tumor is then removed from the tongue using monopolar coagulation and sharp dissection alternately. Careful ligation of all larger vessels. The medial and dorsal parts of the tumor can be safely removed in sano. In the sublingual lateral deposition area, the tumor extends close to the deposition margin. The suture marking of the specimen is performed here. Subsequently, a resection is performed and representative marginal samples are taken from the anterior and lateral sublingual deposition area. A slightly hardened palpable structure in the dorsal left lateral settling area at the base of the wound is also resected. Then careful hemostasis again. Then consult <CLINICIAN_NAME> and discuss the need for a tracheostomy. If the wound defect is extremely large and the wound area extends to the base of the tongue, a decision is made on the need for a tracheostomy given the swelling to be expected here. The patient is therefore repositioned. Injection of local anesthetic with adrenaline and skin disinfection. Then pretracheal skin incision and layered preparation in depth. Then expose the thyroid isthmus. After clamping it off, it is cut off on both sides. The anterior surface of the trachea is then exposed. Then ......... of the trachea between the 2nd and 3rd cricoid cartilage. Creation of the Björk flap. Then epithelialization of the tracheostoma. If the wound is dry, insert a size 8 tracheostomy tube, which should remain in place until the 4th or 5th postoperative day if possible. Now re-inspect the enoral wound surface. However, after removal of the endonasal tube on the left side, a slight bleeding of the mucous membrane can be seen, which is diffuse on closer inspection. It was therefore decided to insert a merocele tamponade into the lower nasal passage. If possible, this can be removed on the 1st postoperative day. Further procedure: A level I neck dissection should now be planned for the patient on both sides. In addition, if there is a pronounced defect in the edge of the tongue, defect coverage using a radial flap should also be planned. The surgery date already scheduled for <2010> may have to be brought forward. The patient is admitted to the intensive care unit for monitoring.