After an initial consultation with the anesthesia colleagues, rigid tracheobronchoscopy is performed after laryngoscopic adjustment of the glottic plane. The glottis, subglottis, trachea and main bronchi were found to be normal and inconspicuous, whereupon the patient was intubated by the surgeon without any problems. The patient is then repositioned for flexible esophagoscopy and gastroscopy: here too, the flexible instrument is inserted into the esophagus without any problems and the patient is visualized under vision as far as the stomach, where a regular folded relief can be seen. On retraction, after aspiration of the air, the esophagus is carefully reflected again, where the mucosal conditions are also normal and inconspicuous. After repositioning the patient again, the hypopharynx and larynx are inspected, where the mucous membrane conditions are also normal and unremarkable in all areas. The base of the tongue is also completely free of irritation and unremarkable on palpation. After repositioning the patient, the mouth retractor is inserted and the oral cavity and oropharynx are inspected. This reveals a clearly enlarged tonsil on the right side, which appears completely non-irritant and inconspicuous on the surface. The mucosal incision is then made close to the uvula and the anterior and posterior palatal arches are sharply dissected. Release of the tonsil at the upper tonsil pole, after exposure, coagulation and separation of the upper pole vessels. The tonsil can then be bluntly dissected from the tonsillar lobe without difficulty. The preparation is carried out with careful hemostasis up to the lower tonsil pole. At the transition to the base of the tongue, the lower pole vessels are carefully coagulated again. Once these have been severed and separated, the tonsil is removed together with a small part of the base of the tongue, the tongue base tonsil. After the intraoperative frozen section diagnosis shows that the tonsil is completely infiltrated by the tumor, the advice is given to resect all areas. This is done in the area of the anterior and posterior palatal arch as well as in the entire area of the tonsil lobe, so that there is a safety margin of about 1 cm from the tonsil bed in all areas. All resections and marginal samples are then found to be tumor-free intraoperatively, so that an R0 resection can be assumed in the primary specimen. Careful hemostasis is then performed again and a nasogastric feeding tube is inserted. Since parapharyngeal fat is exposed here, the patient should be fed via this for a few days. The patient was then repositioned to complete the neck dissection on the right side. Injection of local anesthetic with adrenaline and then skin incision along the front edge of the sternocleidomastoid muscle. Then dissection in depth to the cervical vascular sheath. This is clearly scarred in the area of the vein angle from the primary lymph node removal. The most careful and laborious dissection is required here. In the end, the entire lateral neck preparation can be lifted laterally from the jugular vein. In the course of long dissection. Exposure, neurolysis, displacement and re-embedding of the vagus nerve. Dissection, exposure, neurolysis, displacement and re-embedding of the accessorius nerve. After clearing the accessorius triangle, the entire lateral neck preparation is then dissected and removed from cranial to caudal while sparing the branches of the cervical plexus. The anterior neck preparation is then removed while sparing the branches of the internal jugular vein and external carotid artery. Same procedure in the area of the hypoglossal triangle. Here, too, extremely difficult, laborious dissection with severe scarring. Here too, long-distance dissection after exposure, neurolysis and relocation and re-embedding of the hypoglossal nerve. During dissection, the branches and branches of the internal jugular vein and external carotid artery are also protected. The final result is a neck dissection of levels I B, II, III, IV and V. Subsequent careful hemostasis. Then insertion of a Redon drain and two-layer wound closure and application of a pressure dressing. Then check the enoral findings again. If the wound is dry, the procedure is then completed. After a final consultation with the anesthesia colleagues, the patient goes to the recovery room after an unremarkable course of anesthesia and problem-free extubation.