At the beginning of the operation, the surgeon positions the patient. After induction of anesthesia, the tumor is inspected again. This extends from the soft palate close to the uvula down to the lower tonsillar pole with transition via the glossotonsillar groove to the base of the tongue. Laterally, the tumor appears to extend to the posterior molars. After insertion of the tonsil retractor and insertion of the monopolar electric needle, the tumor is cut around far into the healthy tissue and removed, taking the uvula, the soft palate on the left up to the hard palate border and the upper alveolar ridge, from here to the lower alveolar ridge. Removal of the last molar and preparation via the glossotonsillar groove to the base of the tongue. Removal of the tonsil in its capsule. Mucosa up to the buccal mucosa and the floor of the mouth as a post-resection. Then take lateral and medial edge samples. These are now found to be tumor-free. To confirm the R0 situation, the bed of the two extracted molars is now removed from the medial side to the lateral corticalis with the rose bur, taking the corticalis with it, so that a safe R0 resection appears to be given. Intraoperative demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>. Removal of the tonsil plug. The bridge of the maxilla breaks out at the front. It becomes apparent that the tooth roots could not be preserved, so these are also removed. A residual root may have remained on the left paramedian side. Therefore, request a postoperative maxillofacial consultation. In the further course, repositioning for neck dissection, starting on the left side: skin incision along the anterior edge of the sternocleidomastoid. Exposure of the cervical vascular sheath. Laborious exploration of the neck vessels and preservation of the same for later defect coverage. Dissection in the accessorius triangle and exploration of the accessorius, the hypoglossus and the cervical sinus. Dissection from the digaster to the caudal omohyoid. Removal of the lateral neck preparation while sparing the above-mentioned structures and the main plexus branches. Then dissect the capsule of the submandibular gland in the midline. Dissect caudally, preserving the above-mentioned structures and remove the medial neck preparation. Careful hemostasis and H2O2 irrigation. Now dissection on the right side, essentially identical. Here too, the accessorius nerve, the hypoglossal nerve, the cervical sinus and the cervical vascular sheath can be located and spared. After removal of the lateral and medial neck specimen in regions I to V, careful hemostasis, H2O2 irrigation and insertion of a Redon drain are performed. Subsequently, two-layer wound closure. Now perform the tracheotomy. Skin incision. Subcutaneous preparation of the prelaryngeal musculature. Push them apart in the midline. Dissection of the thyroid gland. Undermining of the thyroid gland, clamping, severing and repositioning of both thyroid globules. Now locate the 2nd and 3rd tracheal cartilage. Creation of a Björk flap with the 3rd tracheal cartilage. Epithelialization of the stoma. Now the intubation is transferred to an LE tube. Then lift the radial flap by cutting around the skin island. Locate the radial artery. Clamp it with the bulldog and observe the saturation while the flap pedicle is dissected from caudal to cranial. Locate the flap pedicle in the crook of the elbow. A relatively small artery and even finer veins can be seen. Therefore, renewed demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>. Decision to lift and use the flap despite difficult conditions. Separation of the radial artery caudally and cranially. Subsequent transection of the same. Now separation of the vein. Dissection of the same. Now lift the split skin from the right groin. This is primarily closed by inserting a Redon drain. The split skin is sutured into the lifting defect of the forearm, the rest of the forearm is closed in two layers accordingly. The flap is then fitted into the lifting defect orally. Suturing in the area of the soft palate and the tonsil and caudally with covering of the exposed bone. Passing the flap pedicle through an artificial fistula between the mandible and the submandibular gland. Then dissection of the superior thyroid artery and the internal jugular vein in preparation for anastomization. The thyroid artery is then removed and an end-to-end anastomosis of the superior thyroid artery to the radial artery is performed. Then end-to-side anastomosis of the accompanying veins in their confluence with the internal jugular vein. This is achieved without any problems using 9/0 sutures as microsurgical re-anastomization. Finally, two-layer wound closure with insertion of a Redon drain on the left side of the neck and completion of the procedure with a vital flap and no indication of complications.