First confirmation of the extent. There is an exophytic tumor of the right tonsillar lobe, completely consuming the tonsillar lobe with transition to the soft palate up to the right-sided uvula base. In addition, the tumor extends slightly over the caudal tonsillar lobe, growth over the glossotonsillar groove to the free edge of the tongue on the right and here infiltration of an area of the tongue measuring approx. 3 cm with a penetration depth of approx. 1 cm. Infiltration also of the circumscribed posterior floor of the mouth. The PEG tube is inserted first. For this, insertion with the gastroscope under laryngoscopic control. Easy pre-scanning into the stomach. With good diaphanoscopy, problem-free puncture of the stomach. The PEG tube is then inserted using the usual suture pull-through method. Transoral tumor resection is now performed. The tumor is cut around with a safety margin of 1 cm. Removal of the uvula and subtotal removal of the soft palate. Resection up to the buccal. Release of the tooth pocket of the posterior mandibular tooth; if close to the tumour, push off the periosteum here and thus achieve good mobilization in the area of the posterior floor of the mouth. The floor of the mouth is also resected with a safety margin of 1 cm. Resection of the tongue section with a safety margin of approx. 1.5 cm. Also safe in sano resection in depth. Basal resection up to the submandibular gland. The tumor area is now completely covered with marginal samples. These are all assessed as free of dysplasia and tumor. Only in the area of the base of the tongue is there an unclear change that cannot be further differentiated histologically. For this reason, a resection is performed later, which is again assessed as completely tumor-free and dysplasia-free. This results in a defect of the posterior floor of the mouth, the edge and base of the tongue, the lateral wall of the pharynx, the posterior wall of the pharynx and subtotally the soft palate. Therefore a clear indication for defect reconstruction. Neck dissection of the left side is performed first. To do this, make a skin incision on the anterior edge of the sternocleidomastoid muscle. Cut through the skin and subcutaneous tissue. Dissection of the platysma. Exposure of the sternocleidomastoid, digastric and omohyoid muscles. Exposure and release of the capsule of the submandibular gland. Subsequent evacuation of levels II a to V a with careful preservation of the facial vein, superior thyroid artery, hypoglossal nerve and accessorius nerve as well as the cervical plexus branches. Final wound inspection. If the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Macroscopically, there are no suspicious nodules. Neck dissection is now performed on the opposite side. The procedure is basically the same here. However, in the area of the jugular facial angle, a coarse and therefore highly visible mass measuring approx. 2 cm can be seen. This can ultimately be extirpated while preserving the facial vein, without definite evidence of perinodal growth. Otherwise, after release of the submandibular gland, in addition to levels II a and V a, while sparing the structures already mentioned on the opposite side. Release of level I b. Here several macroscopic but not suspicious nodules. Subsequent extirpation of the gland. Partial resection of the digastric muscle and thus creation of a wide access to the enoral side, good overview. Protection of the hypoglossal nerve is possible. The radialis graft is now removed. After marking the graft specially configured for the tongue edge and soft palate, cut around the graft. Expose the cephalic vein. Exposure of the superficial ramus, radial nerve, which can be preserved. Exposure of the distal vascular pedicle. Release of the radial artery. Strictly subfascial dissection. The cephalic vein shows no confluence with the deep venous system in the antecubital region, so it is clipped later and not used further. Exposure of a venous confluence and a further venous outflow. Exposure and preservation of the ulnar artery and common interosseous artery. Later, with a normal vital graft and normal blood supply to the hand, removal of the graft after ligation of the feeding and draining vessels. Careful hemostasis. Subsequent careful two-layer wound closure and insertion of the full-thickness skin graft harvested from the right groin. Application of the vacuum pump and application of the Cramer splint in the functional position for full-thickness skin harvesting from the right groin. For this purpose, cutting around an area of skin measuring a good 12 x 7 cm. Strict cutaneous elevation, subcutaneous mobilization. Insertion of a 10 Redon drain. Multi-layered subcutaneous wound closure and skin suture. The graft is now inserted. This is considerably more difficult due to the swelling that has now occurred. Overall, however, sufficient reconstruction of the defect is achieved, combined transorally and transcervically. Positioning of the stem. Preparation of the facial artery in the case of a very slender superior thyroid artery. Passage of the artery in anastomosis with 8-0 Ethilon. Finally, regular venous return via the draining veins. First condition the superior thyroid vein. Perform a venous anastomosis with the coupler system using a coupler size 3.0. There is now largely strong venous return via the second vein. The facial vein is therefore also conditioned and a further venous anastomosis is performed with the size 3.5 coupler. Regular circulation is then achieved. Positive smear tests and excellent graft perfusion, so that a size 10 Redon drain is subsequently inserted and the wound is closed in two layers. Due to the advanced swelling, a final protective tracheostomy is performed. This involves a skin incision at the level of the cricoid cartilage. Cut through the skin and sucutaneous tissue. Entering the infrahyoid musculature. Exposure of the cricoid cartilage and the anterior wall of the trachea. Dissection of the thin thyroid isthmus. Subsequent insertion between the 2nd and 3rd tracheal ring. Creation of a broad-based pedicled Björk flap. Subsequent problem-free transfer to a size 8 low-cuff cannula, which is suture-fixed. Conclusion: Intraoperative R0 resected cT3 cN1 oropharyngeal/oral cavity carcinoma on the right. If the graft heals properly and the graft is intact, a gradual diet can be started from the 8th postoperative day after inspection. Decannulation should be possible in a timely manner.