Introductory consultation with the anesthesia department. First positioning of the patient for transoral tumor resection. Insertion of the mouth retractor. Subsequent marking of the margins. The tumor extends from the middle of the tongue body at the edge of the tongue to the base of the tongue and passes over to the glossotonsillar groove. Here it still partially infiltrates the anterior gauemnian arch. Medially, the tumor extends to approximately the middle of the tongue. Therefore, the first step is to approach the tumor and resect it with the Harmonic ultrasonic knife. The resection is performed under constant visual control and at a sufficient distance from the tumor. Larger vessels are ligated during resection. Follow the tumor dorsally. Detachment of the tumor at the palatal arch. Here resection of the glossotonsillar groove on the right side. Further tracing of the tumor at the medial edge of the deposit in a dorsal direction. This shows a cone that extends beyond the midline. This cone is also cut around and the tumor is removed in toto together with the base of the tongue on the right side. At a point where the tumor has formed the cone medially, the specimen is marked with a suture and sent for frozen section diagnostics. The tumor is barely resected in sano, which is why an additional safety margin is resected from the medial tongue body. Two representative frozen section samples are taken in the area of the margin of the floor of the mouth and palatal arch to ensure R0 resection. These are also sent for intraoperative frozen section diagnostics and are found to be tumor-free. Subtle hemostasis. Repositioning of the patient for PEG insertion. First, insertion of the flexible instrument into the esophagus and visualization up to the stomach. After filling the stomach with air, a positive diaphanoscopy is obtained. Then place the gastric tube in the typical location under visual control, with positive diaphanoscopy and positive tent phenomenon using the thread pull-through method. After aspiration of the insufflated air, mirror back and carefully inspect the esophageal mucosa, which is also non-irritant and inconspicuous. Removal of the instruments. The patient is repositioned for tracheotomy. This is necessary due to the extent of the tumor. Tracheotomy: First injection of local anesthetic with adrenaline on both sides of the neck in preparation for neck dissection and pretracheally. Inverted T-incision and layered preparation in depth. Finding the midline. Dissection of the musculature, which is dissected away to the side. Exposure of the thyroid isthmus. Exposing the lower edge of the cricoid cartilage. Undermining of the thyroid isthmus on both sides, .................................... is ligated. Separation of the isthmus in the midline and exposure of the anterior surface of the trachea. Opening of the trachea between the 2nd and 3rd cartilage clasp and preparation of a Björk flap. Subsequent circular suturing of the trachea in the sense of an epithelialized tracheotomy. The patient was then intubated and a size 7 tracheostomy tube was inserted. The patient was repositioned for neck dissection, initially on the right side. Incision along the sternocleidomastoid muscle. Dissection in depth in layers after cutting through the platysma. Exposure of the cervical vascular sheath and the omohyoid muscle. Exposure of the digaster muscle. This reveals a large conglomerate of lymph nodes in the area of the venous angle. Numerous other lymph nodes can be found in the lateral neck preparation. First expose the cervical vascular sheath. Long-distance dissection of the vagus nerve, which is lifted out of its bed in the sense of a neurolysis and moved medially in a long distance. Re-embedding of the nerve here. Subsequent exposure of the accessory nerve and dissection of the lateral neck preparation of levels II, III, IV and V. Dissection of the anterior neck preparation with preservation of the branches of the internal jugular vein and the external carotid artery. Clearing of the hypoglossal triangle. Long dissection of the nerve and neurolysis. Re-embedding of the nerve after cranial displacement. Exposure of the submandibular capsule. This is subtotally removed. Subsequent exposure of the gland. Preservation of the facial artery and vein after they are first dissected away from the gland. The supplying vessels are cut off. The gland is then detached from the glandular bed. Circular dissection of the gland and exposure of the uncinate process and the excretory duct. Ligation of the excretory duct and subsequent removal of the gland. A tiny defect is revealed in the area of the posterior floor of the mouth, which is generously sutured over with floor of mouth muscles. Taping of the suture with TachoSil. Overall, the neck dissection of the right side revealed numerous suspicious nodules in the five levels. Irrigation of the wound and repeated palpation, whereupon no more enlarged lymph nodes were palpated. Insertion of a Redon drain and two-layer wound closure. Application of a pressure bandage. Transition to the left side: Here, an arc-shaped skin incision is made along a neck fold. Here too, layer-by-layer dissection in depth after cutting through the platysma. Exposure of the cervical vascular sheath and long dissection of the vagus nerve. Neurolysis, displacement and re-embedding of the nerve. Clearing of the hypoglossal triangle after a small lymph node conglomerate is also revealed here. Long-term exposure Dissection of the hpyoglossal nerve, which is also re-embedded after neurolysis and cranial displacement. The accessorius nerve is also exposed. This is also dissected over a long distance and relocated after neurolysis. Re-embedding of the accessory nerve. Dissection of levels II and III, which are completely dissected. Subtle hemostasis. Irrigation of the wound. Insertion of a Redon drain. Two-layer wound closure. Application of a pressure bandage. Repositioning of the patient and enoral wound control. Subtle hemostasis again. The defect cannot be identified here. To prevent a fistula here, TachoSil is still applied to the posterior floor of the mouth. The TachoSil is fixed in place with a ball swab that is sewn on. If the wound is dry, the procedure is completed. Final consultation with the anesthetist.