After appropriate preparation, first attempt to insert a PEG. This is not successful in the absence of diaphanoscopy, so a nasogastric feeding tube is inserted via the left nostril. Then insertion of the T-barrier and start of transoral tumor resection with the ultrasonic knife. The soft palate is resected almost completely on the right side. The resection then extends caudally on the posterior wall of the hypopharynx approximately in the median line. Laterally, pterygoid muscles and the fatty tissue of the soft tissues of the neck are reached. The tumor can thus be dissected out successively with an appropriate safety margin up to the glossotonsillar groove and at the base of the tongue and finally removed. Inspection of the specimen after removal. A muscular cuff is still present at the base of the tumor, but slightly less than at the edges. Therefore, a resection is performed from the muscles at the corresponding site. Samples are then taken from the margins around the defect. All histologies are examined using frozen section histology and are found to be tumor-free, including the main specimen. Subsequently, transition to neck dissection on the right side. The anterior edge of the sternocleidomastoid muscle is skeletonized after a skin incision. Then skeletonize the digastric muscle and successively remove regions II to V while preserving all non-lymphatic structures. There is no indication of a suspicious lymph node. Subsequent evacuation of regions Ia and Ib including submandibulectomy. The defect is completed in the pharyngeal direction. The lingual nerve and the hypoglossal nerve are exposed and can be spared. Dissection of the superior thyroid vein for the subsequent anastomosis. Subsequent transition to the opposite side. Here, regions II to V are dissected in the usual way, preserving all non-lymphatic structures. Here too, there is no clinical evidence of a suspicious lymph node. Insertion of a Redon suction drain on the left side and two-layer wound closure in the usual manner. In the meantime, start lifting the radial lobe graft from the left forearm. The defect measures approximately 11 x 7.5 cm. After an S-shaped skin incision, the superficial vein is dissected distally. The two muscle bellies are then pushed apart with identification of the underlying vascular pedicle. This is dissected circularly. The flap is then first incised ulnarly down to the fascia and dissected radially down to the tendon of the flexor carpi muscle. Similarly, the flap is dissected radially while sparing the sensitive nerve. The pedicle and the entire flap are then detached from its base. The confluence is then dissected cranially, exposing the exit of the radial artery and dissecting two superficial veins beyond the antecubital fossa. The radial artery flap graft was then removed. In the meantime, the split-thickness skin was removed from the right thigh. This is then used to cover the defect on the left forearm. Now insertion of the radialis graft into the oropharyngeal defect. The graft is sutured into the defect transorally, whereby the cranial part is doubled in the area of the soft palate. The graft is then sutured caudally close to the base of the tongue. However, the last 5 sutures are performed transcervically from the right. The arterial anastomosis of the radial artery to the superior thyroid artery is then performed. The two veins of the left arm are then connected to the internal jugular vein using an end-to-side technique. Then carefully stop some bleeding from the flap until the blood is dry. Previously a Redon suction drainage into the right side of the neck. Insertion of an Easy flow drainage. Checking the patency of the venous anastomoses. Two-layer wound closure. In addition, the tracheostomy was performed between the 2nd and 3rd tracheal clasp by <CLINICIAN_NAME> and completion of the mucocutaneous anastomosis. Finally, after completion of the operation, sterile neck dressing and reintubation of the patient on a 9-gauge tracheostomy tube. Conclusion: Transoral resection of a tonsillar carcinoma on the right side and selective neck dissection on both sides with preservation of all non-lymphatic structures. Right oropharyngeal defect coverage with a radial flap graft from the left forearm. Defect coverage on the left forearm with split skin from the right thigh. Additional tracheotomy performed. Unsuccessful attempt to insert a PEG in the absence of a diaphanoscopy.