Inspection of the oropharynx on the left side. An exophytic mass is seen here, which extends at the level of the ascending mandible towards the last molar of the maxilla. The tumor extends caudally into the tonsillar lobe and reaches the tip of the hypopharyngeal side wall. Preliminary consultation with the anesthesiologist. The patient has already been positioned and nasotracheally intubated. Insertion of the mouth blocker. Cutting around the tumor with the electric needle. It can be seen here that the tumor extends to the gingiva of the last molar of the left maxilla. Therefore, tooth extraction in toto with all roots. The alveolus appears tumor-free. A frozen section sample is taken from the alveolar margin, which is found to be tumor-free intraoperatively. Further incision of the tumor caudally with a safety margin of about 4-5 mm. The tumor extends caudally to the lower edge of the tonsil lobe. The resection is performed on the pharyngeal musculature. The anterior palatal arch must also be resected here. The posterior palatal arch is preserved in the cranial part. Lateral exposure of pharyngeal fat, which is coagulated here but appears absolutely tumor-free. Marginal samples are also taken from this area. Border samples are also taken after complete tumor excision in the area of the anterior and posterior margin as well as the cranial and caudal margin. All margin samples are also found to be tumor-free intraoperatively in the frozen section. Subsequent subtle hemostasis. Insertion of a hydrogen-soaked swab. Repositioning of the patient for neck dissection on the left side. Injection of local anesthetic with adrenaline. Skin incision along the anterior edge of the sternocleidomastoid. Dissection in layers in depth after cutting through the platysma. Exposure of the cervical vascular sheath. Clearing of neck dissection levels Ib to V and preservation of all branches of the internal jugular vein and external carotid artery. Also exposing the nerve structures. In this case, long-distance exposure of the vagus nerve in the cervical vascular sheath. Displacement, neurolysis and re-embedding of the vagus nerve. Same procedure for the accessorius nerve and hypoglossal nerve. The cervical profunda can also be preserved. Finally, the entire neck preparation is sent for histopathological examination. In the area of the vein angle, slightly enlarged, macroscopically rather suspicious nodules were found. The final result remains to be determined by histopathology. Dissection in the area of the hypoglossal triangle and in the area of the pharynx was carried out extremely carefully. In the end, it is apparent that there is no penetrating defect to the pharynx. Careful palpation of the pharyngeal side wall, which still appears sufficiently thick, so that the decision is now made not to perform a local reconstruction by means of tissue transfer. The pharyngeal side wall is simply tightened slightly and closed over the exposed fatty tissue as a local mucosoplasty. Insertion of a wound flap. Two-layer wound closure of the neck. Repositioning of the patient for neck dissection on the right side. Here too, skin incision along the sternocleidomastoid after injection of local anesthetic with adrenaline. Layer-by-layer dissection in depth. Exposure and transection of the platysma. Exposure of the cervical vascular sheath. This is also exposed over a long distance. Then dissection of the neck preparation of levels Ib to V. All nervous and vascular structures are also preserved here. As part of the dissection, long-distance exposure, displacement, neurolysis and re-embedding of the vagus nerve at the end of the operation. Same procedure in the area of the accessorius and hypoglossal nerve. Preservation of the cervical profunda here too. Finally, subtle hemostasis and insertion of a Redon drain. Two-layer wound closure. Decision to insert a PEG tube due to the defect and the expected adjuvant therapy. Easy insertion into the esophagus with the flexible instrument. Visual visualization up to the stomach, where a regular fold relief is visible. Locate the diaphanoscopy and the appropriate puncture site. Then insert the PEG tube using the thread pull-through method. Positive tenting phenomenon when puncturing the abdominal wall. Aspiration of the insufflated air and reflection of the esophagus. Dressing application. Transition to tracheotomy. Due to the large wound area, after intraoperative discussion of the findings, decision to tracheotomize the patient, in the sense of a protective tracheostomy. Injection of local anesthetic with adrenaline in the area of the jugulum. Modified Kocher incision and layered preparation in depth. Separation of the infralaryngeal and pretracheal muscles in the midline. Exposure of the very slender thyroid isthmus. This is coagulated and cut in the middle. Exposure of the anterior wall of the trachea. Opening of the trachea between the 2nd and 3rd cartilage clasp. Dissection of a Björk flap. Circular mucocutaneous anastomization of the tracheostoma. Re-intubation to a 7-gauge cannula. Dressing application. Final wound check of the neck on both sides and the enoral wound. Application of a pressure dressing on both sides of the neck. Final consultation with the anesthetist.