After induction of anesthesia by the anesthesia department, transoral endotracheal intubation by the anesthesia colleagues. Positioning of the patient for TE on the left. Dental status determined. Insertion of the McIvor oral spatula. The left tonsil is superficially unremarkable, no exophytic mass, but caudally marked induration. This finding is taken into account during the subsequent resection according to the demo and discussion with <CLINICIAN_NAME>. Now incision of the anterior palatal arch on the left, taking it along and intramuscular, step-by-step dissection in the caudal direction using the dissection technique. No evidence of major vascular bleeding under dissection technique. The dissection procedure is performed according to the instructions of <CLINICIAN_NAME>. The tonsil is coarse in the caudal direction, for this reason resection with a safety margin of approx. 1 cm and thus resection of part of the left tongue base. The macroscopically resected specimen in sano is thread-marked (cranial margin of resection, caudal margin of resection, tongue margin, caudal margin of resection, glossotonsillar groove) and sent for frozen section examination. During this time, a PEG was inserted (described below in the report). Result of the frozen section examination: 2 cm large squamous cell carcinoma of the left tonsil. Cranial margin forming. Caudal resection in the area of the base of the tongue at a maximum of 1 mm with partial coagulation artifacts. Renewed demonstration of findings <CLINICIAN_NAME> and decision to carry out resections at exactly the above-mentioned sites and then to take marginal samples for frozen section examination. Thus generous resection of these sites by <CLINICIAN_NAME>. The resections are sent for final histology. Then representative marginal samples are taken from the above-mentioned sites, which are sent for frozen section. These then show no malignancy. Thus R0-resected T2 tonsillar carcinoma on the left. With now extensive defect from parauvular over the soft palate to caudal to the base of the tongue, renewed demonstration of findings on <CLINICIAN_NAME>, hemostasis using bipolar, finally 2 adjacent sutures to suture over the lateral pharyngeal wall through <CLINICIAN_NAME>. No more evidence of bleeding. No fatty tissue from the lateral pharyngeal wall. Operation completed without complications. Dental status fixed. All swabs complete. No bleeding. Report on PEG placement (see above): Insertion of the flexible esophagogastroscope under bite guard and constant air insufflation, the esophageal mucosa is free on all sides and without irritation, no mass. In the stomach, air insufflation and regular unfolding of the inconspicuous mucosal relief. Clearly visible positive diaphanoscopy. Now placement of a PEG tube using the thread pull-through method in the typical manner, approx. 2 transverse fingers below the costal arch. The patient received 3 g Unacid i.v. perioperatively. A PEG tube was inserted without any problems. Conclusion: R0-resected T2 tonsillar carcinoma on the left in a frozen section after left neck dissection with pN2b neck status (2/23) and placement of a PEG tube. Significantly larger tumor size intraoperatively in contrast to the initial findings. Procedure: Planning of a neck dissection on the right and, depending on swallowing function and local findings, if necessary, defect coverage of the large oropharyngeal defect that has now developed (see above) using a microvascular anastomosed flap graft. Presentation at the interdisciplinary tumor conference and histology discussion.