At the beginning of the operation, the surgeon positions the patient. After induction of anesthesia, a new pharyngo-laryngoscopy is performed, confirming the findings of the preliminary examination. Comparison with the CT findings. It was found that the tumor was relatively well encapsulated, a cN0 situation was present, therefore now after esophagogastroscopy with good diaphanoscopy and insertion of the troicart. After alcohol disinfection, infiltration anesthesia, placement of the PEG tube in the typical manner and subsequent insertion of the tonsil plug. The overview is poor with restricted mouth opening, especially of the caudal part, so that the combined transoral, transcervical approach is preferred. Reposition the patient for this. Alcohol disinfection. Infiltration anesthesia and preforming of a platysmal flap. To do this, first make a skin incision into the subcutaneous tissue. Cut around the suspected defect in the supraclavicular area, lift off the skin laterally and medially of the neck incision above the platysma. Expose the platysma at the level of the clavicle. Separation of the same. Here and fixation sutures skin platysma. Then carefully dissect cranially, taking the platysma and the surrounding connective tissue structures up to the capsule of the submandibular gland and preserving the facial artery and vein. Now expose the cervical vascular sheath, expose the vagus nerve and hypoglossal nerve as well as the accessorius nerve. Clearing out the lateral neck preparation from the omohyoid to the digaster, sparing the aforementioned structures and the main plexus branches. Exposure of the medial neck preparation and removal of the same, including the capsule of the submandibular gland and preservation of the other structures mentioned, including the artery and superior vein. Now dissect the ventral part of the digastric muscle and the styloid muscle. Dissection of the same. Counterpalpation of oral and cervical. The smoothly bordered tumor can be seen and that when entering the pharynx one emerges just caudal to the hypoglossus below the tumor. Therefore, re-insertion of the tonsil stop, cutting around the tumor from the cranial side, including the anterior palatal arch, parts of the soft palate and the lateral pharyngeal wall up to the alveolar ridge. Dissection clearly macroscopically in healthy tissue, including muscle layers on the tumor. Now dissect caudally as far as this is possible without complications, then open the pharynx below the tumor and cut around the caudal parts of the tumor under visual control. Development of the complete tumor specimen which is sent for final histology. Forming a resection in the area cranial to the entrance to the operation, as submucosal growth could not be ruled out by palpation. Subsequently, representative marginal samples are taken circularly. All of these, including the tongue margin sample, were found to be tumor-free by <CLINICIAN_NAME> from the pathology department, so that a safe R0 resection can be assumed. After careful hemostasis and wound irrigation, the caudal pharyngeal opening is widened so that the flap stalk is not trapped; the lingual artery is cut and severed for this purpose. The flap is then swung into the defect; this is achieved without tension up to the upper palatal arch, where the flap is adapted to the mucosal borders and the posterior palatal arch. The uvula remains freely movable. Adaptation to the caudal side. Now turn towards the transverical and reduce the pharyngeal access. Then suture the accompanying connective and fatty tissue of the flap pedicle with the pharyngeal musculature to create a complete closure. Finally, insertion of a Redon drainage and two-layer wound closure by forming a Burrow triangle can achieve complete primary closure. Please apply a pressure dressing to the lower third of the neck scar, never to the cranial third. If problems occur, the lateral part of the flap can be primarily released from the suture and sutured again secondarily.