After intubation by the anesthesia colleagues, entry with the flexible esophagoscope under continuous air insufflation and approach into the stomach. Irritation-free mucosal relief. Subsequent PEG insertion in the usual manner. Now enter with the tonsil retractor and expose the left, histologically confirmed, tumorous tonsil. Mark the resection margins with the electric needle and then generously resect the left tonsil, leaving the posterior palatal arch intact. Part of the base of the tongue is resected caudally. Intermediate bipolar hemostasis. The specimen is then marked with sutures and sent for histological frozen section examination. In the course of the operation, the specimen is found to be tumor-free on all sides. Insertion of a hydrogen swab, bipolar hemostasis and repositioning for neck dissection on the right: Here, first instillation of 10 ml xylocaine with added adrenaline in the area of the front edge of the sternocleidomastoid. Then make a curved incision along the anterior edge of the sternocleidomastoid. Now expose the omohyoid muscle, the accessorius nerve and the digaster muscle. Then expose the entire length of the internal jugular vein. Dissect the neck preparation caudally after exposing the carotid artery and the vagus nerve. Then detach the cranial neck preparation from the upper accessory triangle while protecting the nerve. Now successively detach the posterior neck preparation while protecting all plexus branches. Then complete the anterior neck level II, II, exposing the hypoglossal nerve. Then again bipolar bladder irrigation, hydrogen and Ringer irrigation. Insertion of a Redon drain and two-layer wound closure. Repositioning for neck dissection on the left: Instillation of 10 ml xylocaine with added adrenaline in the area of the anterior border of the sternocleidomastoid muscle. Palpation reveals a large, coarse lump in the depth of the neck. Curved skin incision in the area of the anterior edge of the sternocleidomastoid muscle. Exposure of the anterior edge. This goes approximately to the middle of the dissection seen from the caudal side, as the tumor is already infiltrating the musculature here. Now expose the lower border in the sense of the omohyoid muscle. Visualization of the jugular vein. It can be seen that it runs through the tumor block, with an extremely congested facial vein. Now laboriously locate the digaster muscle and successively release the tumor block in the upper accessorius triangle. The accessorius nerve can be exposed with great effort, as it runs through the tumor. However, it can be separated from the tumor while preserving a small displacement layer. Demonstration of the findings on <CLINICIAN_NAME> and decision to leave the nerve in place. Now, with resection of parts of the sternocleidomastoid muscle, detachment of the tumor specimen laterally. Subsequent medial dissection. The tumor extends to the carotid artery with a clear displacement layer. As the jugular vein runs through the tumor, clamp it caudally and cranially, place 2 lower ligatures as well as 2 re-stitches and remove the vein. The tumor block can now be easily worked out after detachment from the vagus nerve. In between, a swab of tumor secretions is taken and sent for microbiological examination. Further excision of the tumor block with partial removal of plexus branches. The hypoglossal nerve has already been exposed due to dissection. The decision was made to ligate the external carotid artery. Identification of the same, visualization of the thyroid artery and the ascending lingual pharyngeal artery. The external carotid artery is then ligated. Then dissect up to the capsule of the submandibular gland and remove it. Follicularization of the anterior neck and irrigation with hydrogen and Ringer's solution. Minute bipolar hemostasis and insertion of a Redon drain. Then two-layer wound closure. Finally, another enoral check. Absolutely dry wound conditions here. Complication-free completion of the procedure. Patient receives 3 g Unacid i.v. intraoperatively. Please continue this antibiotic treatment 3 x daily for 4 days.