Induction of anesthesia by the anesthesiologist. Nasal intubation by the anesthetist. Insertion of the tonsil blocker and inspection of the tonsil boxes. The tonsil lobe on the left side looks completely unremarkable, on the right side a rough mass of approx. 1 to 2 cm can be felt. It is therefore decided to resect the right tonsil with a sufficient safety margin. Incision of the mucosa with the monopolar needle, then change to the scissors. Dissection of the mass, taking the entire tonsil with the dissection technique using scissors and bipolar forceps. The specimen is thread-marked for histology. The frozen section shows a T1 squamous cell carcinoma, which was completely resected in sano. Modified radical neck dissection on the left (<CLINICIAN_NAME>): Initially skin spray disinfection. Infiltration anesthesia along the anterior border of the sternocleidomastoid muscle. Abjoration of the skin and sterile draping. Creation of a skin incision along the anterior border of the sternocleidomastoid muscle. Cut through the subcutaneous tissue and the platysma. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure of the accessorius nerve. Dissection of the same in an anterior cranial direction. Exposure of the digaster muscle. Exposure of the omohyoid muscle. Subsequent successive dissection along the internal jugular vein. Exposure of the vagus nerve and the common carotid artery. Development of the neck preparation from cranial to caudal. In the area of region II b, a large, coarse mass with a maximum diameter of approx. 2 cm with a clear suspicion of metastasis is visible. Exposure and sparing of the branches of the cervical plexus. Exposure and sparing of the hypoglossal nerve and the superficial cervical nerve. Subsequent dissection of the anterior cervical vascular sheath and removal of the anterior neck specimen. Hemostasis using bipolar coagulation. Wound irrigation using hydrogen peroxide and Ringer's solution. Repeated wound inspection. Completely dry conditions. Placement of a 10 Redon drain. Two-layer wound closure and completion of the neck dissection on the left side without complications. Neck dissection on the right side: The large N3 neck metastasis is located here, it comprises levels II to IV and palpatorily also level V. Sonographically, the sternocleidomastoid muscle and the internal jugular vein are infiltrated and can no longer be delimited. First skin incision and creation of a platysmal flap. Exposure of the sternocleidomastoid muscle. It can be clearly seen that the tumor completely infiltrates the muscle in the middle area as well as in the upper area where the accessorius nerve enters the muscle. The sternocleidomastoid muscle is set off at the lower edge. It can also be seen that the jugular vein runs through the tumor and is already completely thrombosed. The vein is cut off at the lower edge and removed. Exposure of the common carotid artery, which can be pushed away from the tumor, and dissection of the neck metastasis cranially. The upper area shows that the facial artery and the facial vein are also infiltrated; unfortunately, these must also be removed. Further triggering of the metastasis. After visualization of the posterior abdomen of the digaster, the hypoglossal nerve was also found to be infiltrated. After intraoperative consultation with <CLINICIAN_NAME>, this is resected together with the tumor conglomerate. Now complete dissection of the internal carotid artery. It becomes clear that the external carotid artery is also infiltrated. The external carotid artery is removed after the superior thyroid artery has been removed and ligated. The metastasis can be retrieved in its entirety. Then complete the neck dissection in level V, sparing the remaining plexus branches. A few smaller lymph nodes could still be retrieved here. Clearing out the remaining level II b. Level I b and the submandibular gland can be preserved. The external jugular vein could also be preserved, although it is very thin. Conclusion: cT1 cN3 tonsillar carcinoma on the right, resected in sano according to the frozen section. On the right side, the following structures were removed by tumor infiltration: sternocleidomastoid muscle, internal jugular vein, external carotid artery, accessorius nerve, hypoglossal nerve. After receiving the final histology, the patient should be presented at the tumor conference to discuss adjuvant radiochemotherapy or radiotherapy, also with regard to the conspicuous mediastinal and hilar lymph nodes.