Induction and intubation by the anesthetist. Positioning of the head and insertion of wound blocks in the oral cavity. Snaring of the tongue and exposure of the tumor. The tumor is endophytic on the left side of the tongue wall and grows to the midline at the base of the tongue. The tip of the tongue is free on both sides. First mark the edges of the incision using a monopolor needle. Now start the resection in the area of the raphe, in the middle of the tongue and in the posterior tongue area. Here, the raphe is moved strictly downwards. The tumor is palpated at a safe distance from the cutting edge. Further dissection with scissors and forceps. First resection of the medial part, carefully moving from the surface of the tongue downwards and then forwards towards the tip of the tongue. Hemostasis using bipolar coagulation. Now dissect the base of the tongue. Here too, use scissors, forceps and bipolar coagulation. The anterior palatal arch must also be partially resected as far as the mucosa is concerned. The tonsil is left in situ as it is not palpatorily infiltrated. Now dissect the outer edge of the tongue and proceed towards the tip of the tongue. The lingual artery is encountered. This is carefully coagulated and ligated. Expose the lingual nerve, which can be completely preserved. Further resection in the mucosal area of the floor of the mouth. The submandibular gland must be partially resected. The Wharton's duct can be identified and spared. Excision of the tumor with scissors and forceps under bipolar coagulation. Larger blood vessels are carefully coagulated and ligated. Further hemostasis using bipolar coagulation. The entire tumor preparation is thread-marked and sent to the frozen section. In the frozen section itself, all margins were assessed as free. However, in the basal wound area, the resection was described as just in the healthy area. A 1.5 x 3 x 4 cm slice was resected here later. This was ultimately declared tumor-free in a further frozen section. A total of 2/3 of the anterior part of the tongue was preserved. The tip of the tongue itself is completely preserved. A 1/3 resection was performed in the posterior area. The lingual nerve and Wharton's duct were completely preserved. Repositioning, injection and covering for neck dissection on both sides. Start of the modified, radical neck dissection on the left side by <CLINICIAN_NAME>. Skin incision. Separation of the platysma and formation of a small platysmal flap in the ventral area. Exposure of the sternocleidomastoid muscle. Locate the omohyoid muscle and expose it. Then turn to the cranial region and locate the submandibular gland, which is also well visualized. Locate the internal jugular vein. Now completely release the sternocleidomastoid muscle while sparing the external jugular vein. Release of the upper neck block. This shows some enlarged lymph nodes, which were all removed. Exposure of the facial vein, which could be completely preserved. Finding the superior thyroid artery. This was also completely preserved, but is very thin and slender. Now turn to the internal jugular vein. This is triggered by fat and connective tissue. Release of the superficial fatty tissue cranial to the omohyoid muscle. Further evacuation of the fatty tissue lying above the plexus. Exposure of the accessorius nerve. Release of level IIb above the accessory nerve. Irrigation and bipolar coagulation to stop bleeding. Turn to the opposite side and perform the modified radical neck dissection by <CLINICIAN_NAME>. Skin incision and similar procedure as on the left side. First separation of the platysma and formation of a small platysmal flap in the ventral area. Exposure of the sternocleidomastoid muscle and release of this muscle. Finding the external jugular vein. This can remain completely intact. Locate the lower border by exposing the omohyoid muscle. Then locate the upper border by exposing the submandibular gland. Then start releasing the upper neck block, beginning at the omohyoid muscle. Release of the fatty tissue in this area. No lymph nodes are visible. At the level of the superior thyroid artery, no further dissection is carried out downwards. The superior thyroid artery itself is also a very slender vessel on this side. However, it can be completely preserved. Exposure and release of the internal jugular vein. The facial vein is exposed and completely preserved. Removal of fatty tissue which lies above the plexus. Exposure of the accessorius nerve and release of the upper accessorius triangle. Wound irrigation with H202 and Ringer. Bipolar coagulation to stop bleeding. Insertion of Redon drains on both sides. During the neck dissection on both sides, all relevant vessels for a possible subsequent flap plasty were preserved (external jugular vein, facial vein, internal jugular vein, superior thyroid artery). The patient is now repositioned and the resection in the basal wound bed described above is performed. Then turn to the tracheotomy. Skin incision just below the cricoid cartilage. Now dissect in depth. Push the infrahyoid muscles to the side. A very small thyroid gland is now encountered. This can be pushed completely to the side and does not have to be severed. Removal of connective tissue on the trachea. Insertion between the 2nd and 3rd cricoid cartilage into the trachea. Unfortunately, this breaks the cuff. Formation of a basally pedicled Björk flap downwards. Incision of the Björk flap and the upper and lateral tracheal margin in the usual manner. Re-intubation. Now check the mouth and tongue area again. Remaining hemostasis here. End of the operation with dry blood. Conclusion: According to the frozen section, the tumor was resected in sano at all edges. The tip of the tongue, the lingual nerve, Wharton's and Wharton's canal were preserved. The lingual artery was carefully ligated. During the neck dissection, all vessels necessary for a possible flap plasty were preserved. If a flap plasty is required secondarily to improve function, a radial flap is recommended. After receiving the final histology, the patient must be presented at the tumor conference for possible planning of adjuvant therapy.