After induction of anesthesia by the anesthesia colleagues, rigid tracheoscopy is performed using the 0 degree optic. Passing the glottis and entering endotracheally. The mucosal conditions are unremarkable on all sides up to the tracheal bifurcation. Subsequently problem-free intubation by the surgeon. Then insertion of the mouth guard and insertion with the Kleinsasser C-tube. Adjustment of the endolarynx. The mucosal conditions are inconspicuous on all sides. Then enter the piriform sinus on the right and left. This can be freely unfolded on both sides and is lined with smooth mucosa on all sides up to the tip of the piriform sinus. In the area of the postcricoid and the esophageal entrance, the mucosa is also normal on all sides. Subsequent inspection of the vallecular region and the base of the tongue. Here, too, there is no evidence of a primary tumor. Then proceed to inspection of the rest of the oropharynx. Start on the left side. Primary inspection also reveals a non-irritant, inconspicuous tonsil lobe. However, during the meticulous inspection in the case of an externally expressed suspicion of a left-sided tonsillar carcinoma, a superficially growing exophytic growth appears deep in a crypt. This is limited to the central area of the left tonsil. The anterior and posterior palatal arch appears macroscopically tumor-free. Subsequent inspection of the right tonsillar lobe. A superficial leukoplakic mucosal change was found, which was biopsied and sent for definitive histology. Otherwise, there was no evidence of a tumor in the rest of the oropharynx or oral cavity either by inspection or palpation. Subsequent demonstration of the findings and planning of the further procedure with <CLINICIAN_NAME> and <CLINICIAN_NAME>. The decision is made to perform a tumor tonsillectomy due to the circumscribed tumor growth. Insertion of the Mc Ivor oral spatula. Parauvular incision of the mucosa and performance of a tomortonsillectomy under strict control of the marcroscopic tumor borders. Partial resection of the anterior and posterior palatal arch and extension of the resection towards the base of the tongue. The tumor resection is made in toto for frozen section dignostics. Suture marking is performed cranially and in the area of the anterior palatal arch. After meticulous inspection of the tumor resectate, the decision is made to send a flat resectate in the area of the anterior palatal arch for frozen section diagnostics. This is followed by meticulous. Hemostasis using bipolar coagulation. Transition to placement of the PEG tube. Insertion of the endoscope under visualization and constant air insufflation into the stomach. Only slight reflux-associated mucosal changes are seen in the distal esophagus. However, there is no evidence of a secondary malignancy. Subsequent entry into the stomach. Here, too, a regular, non-irritant gastric mucosal relief is seen. The diaphanoscopy is then performed and the PEG tube is inserted in the typical manner using the suture pull method. During the telephone frozen section announcement, invasive tonsillar carcinoma with marginal filling in the area of the central wound bed. Furthermore, suspected cis-spurs in the area of the cranial resection margin in the area of the upper tonsil pole and the caudal resection margin towards the base of the tongue. ....... Cis spurs are also visible at the resection margin of the anterior palatal arch. However, the resected resectate is completely tumor-free. Thus, generous resection cranially in the area of the upper tonsil pole transition anterior palatal arch, in the area of the central wound bed laterally and caudally towards the base of the tongue. The resection is performed by <CLINICIAN_NAME>. Resection is performed laterally up to the neck fat. Subsequent meticulous hemostasis using bipolar coagulation. Due to the more extensive tumor tonsillectomy, further waiting of just under 10 minutes and completion of the operation with a dry wound bed. Conclusion: Due to the unexpectedly large extent of the tumor in the frozen section diagnosis, this is a cT2cN2c tonsillar carcinoma on the left. The tumor resection is clinically macroscopically clearly sano. With regard to the pending neck dissection, wait at least two weeks, as otherwise there is a risk of a penetrating defect afterwards enorally. As the patient was not ......tomized, the patient is transferred to the local intensive care unit awake and breathing spontaneously for monitoring.