(<CLINICIAN_NAME>) Induction of anesthesia and intubation transnasally by the anesthesia colleagues. Placement of a PEG using the thread pull-through method by <CLINICIAN_NAME> and <CLINICIAN_NAME>. No complications and no abnormalities. Insertion of the tonsil plug and inspection of the oropharynx on the right side. A coarse, exophytic tumor is seen at the upper pole of the tonsil, which grows laterally and includes the upper tonsil. The posterior and anterior palatal arch are only partially infiltrated. Demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>, who alternately resect this tumor. The tumor is thread-marked for frozen section. The pathologist determines an R0 situation. The lateral pharyngeal muscles on the right side are still sufficiently intact, so the decision is made to perform a neck dissection on both sides. Initially start on the left side. Skin incision on the anterior edge of the sternocleidomastoid muscle. Creation of a platysma flap cranially. Exposure of the sternocleidomastoid and omohyoid muscles. Exposure of the nervus accessorius and the cervical vascular sheath. Free preparation of the internal jugular vein and removal of the neck block II a to V a, sparing the plexus branches. With the exception of the external jugular vein, all structures can be preserved. Switch to the opposite side. Here you can already feel a rough swelling and an immobile sternocleidomastoid muscle from the outside. Skin incision in the usual manner. Depiction of the sternocleidomastoid muscle in the caudal region. In the cranial region, the tumor can just be detached from the platysma, but no longer from the sternocleidomastoid muscle. It was therefore decided to remove the muscle in the lower part, cut through the sternocleidomastoid muscle and expose the cervical sheath. Detachment of the neck preparation from level V a cranially, in the area of the internal jugular vein/ facial vein angle, the metastasis cannot be detached from the internal jugular vein, so the decision is made to detach the vein in front of it. Detachment of the metastasis including the neck block. In the upper part, first expose and ligate the internal jugular vein at the base of the skull. Detachment of the neck block with the metastasis while sparing the internal and external carotid artery. The internal carotid artery has a pronounced kinking in the upper area, but can be completely spared; the hypoglossal nerve can also be completely spared. The upper part of the cervical plexus branches must also be removed as well as the accessorius nerve. Hemostasis by means of bipolar coagulation. Wound irrigation and insertion of drains and double wound closure on both sides. Performance of the tracheotomy by <CLINICIAN_NAME>. (<CLINICIAN_NAME>) First palpation of the thyroid and cricoid cartilage, horizontal skin incision at the level of the cricoid cartilage and dissection in depth under palpatory control up to the thyroid gland. Exposure of the thyroid isthmus, undermining of the same and transection using bipolar coagulation. Subsequent meticulous hemostasis using bipolar coagulation. Blunt dissection of the trachea, after another palpatory check, incision of the trachea between the 2nd and 3rd cartilage, widening of the incision laterally while protecting the cuff of the inserted tube. Subsequently suture for tracheotomy in the typical manner. Check again for hemostasis, which is present. Skin suturing to narrow the skin incision and completion of the tracheostomy without any indication of complications. Subsequent two-layer wound closure of the neck dissection on both sides, after repeated bipolar coagulation on the right side there is now hemostasis. Connection of the Redon drains. Problem-free intubation with the help of the anesthesia colleagues to a size 8 tracheostomy tube, suturing of the same and completion of the procedure without any indication of complications after head repositioning by the first surgeon. Sterile wound dressing.