First transoral tumor resection: Firstly, bridle suture of the tongue. Followed by Mc Ivor spatula or retractor insertion. Tumor is resected on all sides with a safety margin of 1 to 1.5 cm. Later, the anterior palatal arch, the tonsil and parts of the pharyngeal wall and the base of the tongue up to the middle of the tongue are also resected. During resection, the deep external tongue muscles are also resected; the lingual nerve cannot be preserved and must be resected as well. The resection extends deep down to the submandibular gland. The entire preparation is marked with sutures. In addition, frozen sections are taken basally. Parts of the pharyngeal wall and the submandibular gland as well as external tongue muscles are sent in as basal margin samples for the frozen section. In the frozen section, basal margin samples are tumor-free, but the tumor extends at least as far as the cranial edge of the specimen. Therefore, the cranial mucosa including soft tissue is resected again. In addition, a cranial margin sample is taken from the soft tissue area. Now tumor-free in the frozen section. Thus R0 situation. Subsequent careful hemostasis in the entire wound area. Fatty tissue is already partially exposed next to the pharyngeal muscles. The submandibular gland and the facial artery are exposed caudally. The facial artery is ligated once. Muscle tissue is then sutured over the gland and the facial artery using Vicryl 3/0 sutures. Finally, irrigation and further careful hemostasis. No more bleeding on final inspection. No neck dissection on the right due to the extent of the resection on the right. The decision is made to perform the left neck dissection first. PEG placement and tracheostomy are also indicated. First modified radical neck dissection on the left (<CLINICIAN_NAME>, <CLINICIAN_NAME> in alternation) Skin incision in a typical manner in front of the sternocleidomastoid muscle. Then dissection of the lymph node fat packet from the sternocleidomastoid muscle. Exposure of the digastric and omohyoid muscles. Exposure of the accessor nerve, internal jugular vein, internal and external carotid artery, vagus nerve and hypoglossal nerve. Development of the dorsal neck preparation and preservation of the branches of the cervical plexus. Some conspicuous lymph nodes. Then develop the anterior neck preparation, exposing and preserving the hypoglossal nerve and superior thyroid artery. Then irrigation of the wound area with H2O2 and Ringer's solution and careful hemostasis. Wound closure in layers and insertion of a Redon drain. Subsequent PEG insertion: advancement of the esophagoscope into the stomach. Insertion of a 9-bore abdominal wall tube in a typical manner without complications. Fixation to the abdominal wall in a typical manner. Then tracheostoma creation: Small Kocher collar incision. Dissection through subcutaneous tissue to the infrahyoid musculature. This is split medially. Subsequently expose the thyroid isthmus, pass under it, clamp it, cut it open and treat it with stitches. Now expose the trachea. Entering the 2nd intercartilaginous space. Creation of a small Björk flap. Epithelialization of the same. Re-intubation and insertion of an 8 mm tracheal cannula. Finally, enoral inspection again. No bleeding. Completion of the procedure without complications. Patient admitted to the intensive care unit for postoperative monitoring. Overall extensive resection transorally for cT2 to cT3 oropharyngeal carcinoma on the right. Due to the depth, neck dissection is certainly not indicated for another 2 to 3 weeks. If there is an R1 situation somewhere towards the basal area, a resection with flap coverage would be indicated. If neck dissection remains the case, removal of the submandibular gland should not be performed in any case, as otherwise there is a risk of a continuous defect.