After appropriate preparation, transoral tumor resection is performed first. The tongue is disluxed after setting the mouth retractors. Now look at the ulcer measuring approx. 2 x 2 cm on the left edge of the tongue, approximately in the middle. The tumor is then resected macroscopically 1 1/2-2 cm from the resection margin on all sides. The healthy musculature is viewed macroscopically. Suture marking of the specimen, which is sent in for frozen section histology diagnostics. Tumor infiltrates can still be seen in the ventral margin and in depth to the internal musculature as well as lymphangiosis towards the floor of the mouth in a lateral direction. Corresponding resections are then carried out at the corresponding sites, followed by renewed marginal samples further laterally. All of the marginal samples proved to be tumor-free. In the resection of the tumor base, isolated disseminated tumor nests are found in healthy muscles. However, the defect now covers the entire left tongue up to just before the base of the tongue, so that further resection is not possible. The remaining right tongue body is then adapted again in several layers with mattress sutures and sutured to the left resection margin. In the meantime, after disinfecting the skin, a sample is taken from the mass in the right envelope fold. After skin incision, the mass is dissected under the skin and removed. A frozen section histology also reveals a carcinoma corresponding to that in the tongue. Histologically for the time being. Careful hemostasis by bipolar coagulation. Two-layer wound closure. Sterile dressing. Subsequent transition to tracheostomy. The patient cannot be intubated either conventionally or with the GlideScope. Only flexible bronchoscopy. In addition, postoperative dysphagia with aspiration is to be expected due to the extensive tongue resection. A tracheostoma is therefore created. After skin incision, preparation of the linea alba. The muscles are pushed apart. Pass under the isthmus and place in the midline. Thus exposing the first 4 tracheal clasps. Opening of the trachea between the 2nd and 3rd tracheal clasps. Completion of the mucocutaneous anastomosis. Removal of the tube and problem-free intubation of the patient onto a 9-gauge cannula. End of the operation, handover of the patient to anesthesia.