PEG insertion: Entering the oesophagus with the flexible gastro-oesophagoscope, careful pre-scanning into the stomach. Air insufflation and identification of the anterior wall of the stomach. Perform a positive diaphanoscopy and then place the PEG tube in the area of the lateral canal in the usual manner using the thread pull-through method. Aspiration of air and subtle retraction of the endoscope with constant air insufflation. Neck dissection on the right: Start with neck dissection on the right side using a skin incision in the area of the old scar. Separation of the cutaneous-subcutaneous tissue and identification of the platysma. Overall, extremely scarred conditions are seen here following neck dissection and radiotherapy. In consultation with <CLINICIAN_NAME>, it was decided not to proceed with the neck dissection. One reason is the current ycN0 neck status, the scarred conditions and, in particular, a possible secondary microvascular defect reconstruction of the tongue. Therefore, no further action is taken and the wound is closed again. After appropriate preparation, first insert the retractors and dislodge the tongue at the fixation suture. Then look at the tumor located medially in the posterior third, which extends a little further to the right than to the opposite side by palpation. Start resection at the anterior left margin. Here, the tumor is successively removed through the healthy musculature at an appropriate safety distance using the monopolar caustic technique. First, resection is performed on the left edge of the tumor in order to preserve the lingual artery, which is ultimately successful. The tumor is then successively removed from the left side through the muscles of the inner tongue. A sufficient safety margin can also be maintained in the area of the base of the tongue. The resection is somewhat more extensive on the right side, but a narrow strip of tissue remains in the area of the base of the tongue. Careful hemostasis by bipolar coagulation. On inspection of the resectate, the left anterior tumor resection margin is slightly less distant at the same side as the tumor. Therefore, a resection is performed on the tongue. Subsequently, marginal samples are taken from the entire circumference at the base of the tumor for a frozen section histological examination. These all proved to be tumor-free, so that an R0 resection can be assumed. Although the subsequent defect is extensive, it does not infiltrate particularly deeply, largely preserving the base of the tongue, so that no construction is necessary. Neck dissection can also be dispensed with in the case of cN0 status and previous neck dissection on both sides. Removal of the instruments without tooth damage and transfer of the patient to anesthesia. Conclusion: Transoral tumor resection of the median-dorsal tongue tumor. Intraoperative rapid section histologic R0 resection. No neck dissection in the case of previous neck dissection due to the nasopharyngeal carcinoma and primary reconstruction due to the configuration of the defect