After induction and intubation by the anesthesiology colleagues, the PEG is inserted first. This is done with the gastroscope under laryngoscopic control. Easy pre-scanning into the stomach. Here, with excellent diaphanoscopy, the stomach is punctured without any problems. The PEG tube was then inserted using the usual thread pull-through method. The stomach and oesophagus were unremarkable. Now re-inspection of the primary tumor region. Pharyngo/laryngoscopy revealed a tumor as described above in the area of the right base of the tongue extending into the vallecula and here circumscribed to the epiglottis, tumor extension also on the right side of the pharyngeal side wall. Adjustment of the primary tumor region with the distractor. Successive resection of the primary tumor with the 5 watt CO2 laser. Resection while maintaining a safety distance of approx. 1 cm, very good microscopic control in the mucosal region, caudal resection in the area of the pharyngeal wall below the tonsillar lobe or with partial removal of the tonsillar lobe. Resection in the area of the pharynx superficially under only sparse musculature, taking the musculature up to the entrance of the piriform sinus. Separation from the base of the tongue. Here, under good depth control, complete resection with superficial removal of the right-sided base of the tongue. Resection up to the petiolus. In the area of the medial base of the tongue or towards the middle of the base of the tongue, a tumor cone appears to be pulling into the depths. Therefore, after complete mobilization of the tumour and due to the tumour mass, targeted resection is performed here. Inclusion of the lingual epiglottis surface. No cartilage infiltration here. Inclusion of the vallecula up to the opposite side. No tumor growth towards the aryepiglottic fold. The removed specimen now shows the previously described cone basally, otherwise completely healthy tissue on all sides towards the depth. Slightly narrow resection margins in the area of the vallecula after extirpation, otherwise macroscopically wide in sano resection on all sides. Post-resection is now performed in the area of the tumor cone. This is carried out far into the healthy tissue, also to widen the safety margin in the area of the vallecula. The entire tumor, both in the area of the mucosal margins and basally, is then covered with margin samples. All tumor margin samples are free of tumor and dysplasia, so that an R0 resection is achieved. A protective tracheotomy is then performed in the case of dry enoral wound conditions due to the extensive wound area. To do this, enter horizontally approx. 1 transverse finger below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure of the infrahyoid musculature. Exposure of the cricoid cartilage. Exposure of the anterior surface of the trachea. Due to the position, insertion between the 1st and 2nd tracheal ring. Performing a visor tracheotomy. Incision with insertion of the mucocutaneous anastomosis. Subsequent problem-free transfer to size 8 low cuff cannula. Neck dissections are then performed. Start with the right side. Submandibular incision along the skin tension lines. Cut through skin and subcutaneous tissue. Dissection of the platysma. Dissection of the platysma. Exposure of the sternocleidomastoid, omohyoid and digastric muscles. As previously described sonographically, a metastasis-suspicious mass measuring approx. 3 cm is seen in the jugulofacial angle. Clearing of the anterior neck preparation with preservation of the facial vein, the superior thyroid artery and the cervical artery. Dissection of the internal jugular vein, which is very strong caudally and tapers significantly in the area of the jugulofacial angle in the area of the metastasis. Preservation of the vein. No growth beyond the capsule. Exposure of the accessorius nerve. Release of the accessorius triangle and release of level V a with careful protection of the cervical plexus branches. Exposure and protection of the vagus nerve, hypoglossal nerve and all external carotid arteries. Initial exposure and protection of the external jugular vein and the auricular nerve. Careful wound inspection. Irrigation with H2O2 and Ringer's solution. Insertion of a 10 Redon drain and careful, two-layer wound closure. Turning to the opposite side. In principle, exactly the same procedure here, after exposing the adjacent and limiting muscles, preservation of the external jugular vein and the auricular nerve. Release of the anterior neck preparation with careful protection of the facial vein, the superior thyroid artery and the cervical artery. Here, too, metastasis-suspected lesion in the jugulofacial angle, here with pronounced widening of the vein. Exposure and preservation of the accessorius nerve. Dissection of the metastasis. Here, too, no growth beyond the capsule, but, as described above, pronounced tapering of the internal jugular vein, which is deposited here at this point, with outgoing vessels and vulnerability, with a cranial caliber thickness of approx. 2 mm. Clearing of the accessorius triangle and, due to the location of the metastasis, also clearing ........... Level V a's. Preservation and protection of the vagus nerve and hypoglossal nerve as well as all external carotid artery branches. Here too, final wound irrigation with H2O2 and Ringer's solution. Finally, dry wound conditions. Insertion of a 10 Redon drain and careful, two-layer wound closure. After applying a wound dressing, re-insertion with the small irrigation tube under dental protection to inspect the wound conditions. Circumscribed punctual monopolar hemostasis. Finally, completely dry wound conditions on all sides and completion of the procedure, after repositioning the patient, without any indication of complications. The patient received intraoperative intravenous antibiotics with Unacid 3 g. Please continue this for 24 hours postoperatively. Conclusion: Intraoperative R0-resected cT2 cN2c tongue base carcinoma on the right. After receiving the definitive histology, presentation at our interdisciplinary tumor conference to determine the adjuvant therapy procedure. Postoperatively, please feed via the inserted PEG tube for at least 5 to 7 days; if the wound is healing properly, oralization with water/tea can be attempted beforehand if necessary. Depending on swallowing function, decannulation from the 7th postoperative day.  