Induction of anesthesia by anesthesia colleagues. Intubation via the existing tracheostoma by the anesthesia colleagues. Entry with the Kleinsasser tube and inspection of the hypopharynx and larynx. There is an exophytic mass in the supraglottis area, starting at the petiolus of the epiglottis, passing to the aryepiglottic fold, occupying the entire arytenoid cartilage on the left side, pocket fold and vocal fold. The mass extends to the medial and anterior wall of the piriform sinus, partially also to the lateral wall. Enter with the 0° view and inspect the subglottis. No tumor infiltration here. Sterile washing and draping. Creation of an apron flap in the usual manner. Neck dissection on the right (<CLINICIAN_NAME>): Skin incision in the sense of an apron flap. From right to left, cutting through the cutaneous subcutaneous tissue and the platysma. Identification of the external jugular vein on the right side. Subplatysmal dissection and creation of the apron flap. Identification of the sternocleidomastoid muscle and dissection of the anterior edge of the muscle in depth. The branches of the cervical plexus are revealed at the lower edge of the muscle. Dissection along the muscle cranially and exposure of the accessorius nerve. Expose the submandibular gland and open the glandular capsule. Raise the upper end of the capsule to securely protect the marginal ramus. Identification of the venter posterior digastric muscle and dissection on the digastric muscle ventrally towards the hyoid bone. Identification of the auricularis magnus nerve on the sternocleidomastoid muscle. Identification of the omohyoid muscle and dissection on the muscle up to the hyoid bone. Dissection on the internal jugular vein. Division of the neck preparation on the internal jugular vein into a lateral and a medial resection. Identification of the hypoglossal nerve. This can be preserved during dissection. First detach the lateral neck preparation from cranial to caudal on the deep cervical fascia. Particular care is taken not to injure the accessorius nerve or the branches of the cervical plexus. Release the medial neck preparation. Care is taken to preserve the arterial and venous vessels. Completion of the neck dissection on the right side without complications. Bipolar coagulation to stop bleeding. Wound irrigation. At the end, the wound is dry. Neck dissection on the left side: A large metastatic conglomerate can be seen on the left side, which partially grows into the sternocleidomastoid muscle. The sternocleidomastoid muscle is visualized and partially resected in the area of level II to IV. Exposure of the submandibular gland. Exposure of the omohyoid and digastric muscles and the accessorius and hypoglossal nerves. A thick tumor conglomerate can be seen, ranging from level II b to level IV. This conglomerate infiltrates the hypoglossal nerve, parts of the cervical plexus, parts of the sternocleidomastoid muscle, the internal jugular vein, the external jugular vein, the external carotid artery with all its branches and also the wall of the piriform sinus and parts of the thyroid cartilage. The internal jugular vein must be separated above and below. The external carotid artery is removed. The metastasis had to be laboriously dissected from the common and internal carotid artery for this purpose. Man sees clear tumor infiltration of the pharyngeal musculature. Demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>. It is decided to resect this part of the pharyngeal wall. Release the larynx by removing the hyoid bone. Detachment of the thyroid gland and release of the piriform sinus on the right side; this is not possible on the left side due to the tumor. Entering the pharynx via the right side. Pull out the epiglottis and cut around the tumor in the pharyngeal region and at the postcricoid region down to the esophageal entrance. Here, the tumor can be removed. Separate the larynx below the cricoid cartilage and take marginal samples. All marginal samples are tumor-free in the frozen section. Consultation with <CLINICIAN_NAME>. He recommends avoiding a flapplasty. He recommends releasing the base of the tongue to reduce the tension on the pharyngeal suture. Now release the base of the tongue using <CLINICIAN_NAME>. Then insertion of a Provox-Vega prosthesis. Perform a myotomy at the insertions of the sternocleidomastoid muscle and an esophageal myotomy and now perform a three-layer pharyngeal suture with a "T" at the base of the tongue. Insertion of Redon drains and two-layer wound closure. Application of a pressure bandage and completion of the procedure without complications. Post-operative X-ray swallowing on the 14th postoperative day, followed by diet reconstruction.  