First laryngoscopy and pharyngoscopy: The exophytic process is seen at the location described. Indication for surgery given. Lateral infiltration into the wall too deep for laser resection. Position the patient, disinfect the skin, inject a total of 10 ml Ultracaine 1% with adrenaline in the area of the apron flap on both sides and cover all surgical areas with sterile drapes. First creation of an apron flap subplatysmal and dissection up to the submandibular gland and hyoid bone. Then neck dissection on the right: Dissection of the fat lymph node package from the sternocleidomastoid muscle. Exposure of the omohyoid muscle and digastric muscle. Exposure of the internal and external carotid artery as well as the internal jugular vein, facial vein and external jugular vein. Exposure and preservation of the superior thyroid artery, the superior laryngeal nerve, the vagus nerve, the accessorius nerve and the hypoglossal nerve. Then develop the neck preparation, initially dorsally, exposing and preserving the branches of the cervical plexus. Then develop the anterior neck preparation. This results in evacuation of levels II to V. Neck dissection on the left side: This is performed in the same way as on the right side. All structures are exposed and preserved. This results in evacuation of levels II to IV. Then tracheotomy: splitting of the infrahyoid musculature. Exposure of the thyroid isthmus, which is passed underneath, clamped, severed and supplied with puncture ligatures. A tracheotomy is created between the 2nd and 3rd cartilage using a wide pedicled Björk flap. This is epithelialized caudally. Subsequently reintubation and insertion of an 8 mm tracheal cannula. Tumor resection via lateral pharyngotomy on the right: exposure and isolation of the hyoid bone and superior cornu of the laryngeal skeleton. Entry into the pharynx at the level of the hyoid bone. Exposure of the tumor. Incision of the tumor with a safety margin of at least 1.5 to 2 cm on all sides of the macroscopically visible tumor. Removal of the hypopharyngeal side wall/front wall. Lateral thyroid cartilage is also removed as it is located in front of the deepest tumor infiltration. The edge of the epiglottis with vallecula and aryepiglottic fold on the right is also removed up to the arytenoid cartilage, from which the mucosa is removed, but which ultimately does not need to be removed itself. Resection includes posterior lateral areas of the postcricoid region. On the specimen, the tumor is clearly removed macroscopically in healthy tissue. The specimen is thread-marked and sent for frozen section. Carcinoma in situ infiltrates are still visible in the lateral epiglottis margin and arytenoid region. Therefore, a resection is performed in the area of the arytenoid fold, the entrance to the piriform sinus up to the epiglottis and samples are taken from the margins. These are now tumor-free. So finally R0 resection. Defect size now indication for radial flap. Size of the flap approx. 9 x 6 cm. This is drawn on the left forearm. Drawing of a skin monitor. Lift the flap first from the ulnar and then from the radial side. Take the skin monitor and the superficial venous system with you. Locate the vascular pedicle under the brachioradialis muscle. Visualization and tracing into the crook of the elbow. After clamping the radial artery caudally, it is removed after an appropriate time with constant saturation around 100% and ligated proximally and distally using 4-0 Prolene puncture ligatures. Successive dissection of the flap with the pedicle in the direction of the antecubital fossa. Outgoing vessels are bipolarly coagulated or treated with clips. Exposure of the radial artery with entry into the brachial artery in the antecubital fossa. Also visualization of the interosseous artery. Exposure of the deep venous system with connection to the superficial venous system. Cephalic vein shows 2 larger outlets. Finally, removal of the flap. The veins are ligated. The radial artery is placed in front of the entrance to the interosseous space, preserving it, and closed using 6-0 Vascufil sutures. The cutaneous nerve to the skin island is carefully preserved and integrated into the flap to its maximum length. The flap is then irrigated with heparin solution. The flap is successively incorporated into the defect using 3-0 Vicryl single button sutures. Tension-free and complete closure. The cutaneous nerve is then dissected to just in front of the skin monitor and knocked down towards the end of the superior laryngeal nerve. Conditioning of the nerve endings. Nerve suture with 9-0 Ethilon single button sutures. Subsequent conditioning of the flap vessels with connection on the right side. The radial artery is anastomosed with the superior thyroid artery using 8-0 Ethilon single-button sutures. After opening the clamp, good arterial flow, good venous return. Both ends of the cephalic vein are conditioned. The larger outlet is anastomosed with an outlet from the facial vein. The other, smaller end of the cephalic vein is then anastomosed with a smaller outlet from the internal jugular vein, also using a 2.5 mm coupler. Good venous return in each case. Positive smear phenomenon. The thyroid gland is then stitched over the distal end of the flap and sutured to the remaining infrahyoid muscles. This protects the distal flap tip against fistula formation. Careful irrigation of the entire wound area, careful hemostasis. Knock back the apron flap. Wound closure in layers with insertion of a Redon drain on both sides. Complete epithelialization of the tracheostoma. The defect on the forearm is primarily closed cranially. To close the remaining caudal skin defect of approx. 9 x 6 cm, a 0.8 mm thick split-thickness skin graft is harvested from the right thigh using the dermatome. The skin is successively incorporated into the forearm defect. The thigh is covered with a vein dressing. The forearm is covered with a hydrogel-Mepilex dressing. Apply a cotton swab dressing on top. Wrap with absorbent cotton. Application of a Kramer splint, which is adjusted and wrapped with an elastic bandage in a functional position. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue heparin perfusor, which was started intraoperatively at 500 units per hour, for 5 days. Control of the flap via skin monitor and Doppler probe for 5 days according to the schedule. Patient should be fed via PEG tube for approx. 10 days, then gradually build up diet. As the defect in the right postcricoid region and the piriform sinus was relatively extensive due to the necessary resection and removal of marginal samples, a protracted postoperative swallowing disorder is certainly to be expected. Therefore, plan swallowing rehabilitation at an early stage. Therefore also sensitization of the radial lobe. Overall cT2-3 cN2b hypopharyngeal carcinoma on the right. Postoperative radiochemotherapy should certainly be discussed.