Patient with histologically confirmed squamous cell carcinoma of the oropharynx. Pharyngoscopy and laryngoscopy again before surgery: the exophytic, partly ulcerating tumor is seen, which is located on the epiglottis, partly growing through it from the vallecula on the right over the midline into the vallecula region on the left. Base of tongue not affected macroscopically. First tracheotomy: small Kocher's collar incision, then splitting of the infrahyoid muscles and exposure of the thyroid gland. Dissection of the thyroid gland, which is stitched and ligated. Subsequent exposure of the trachea. A small, modified Björk flap is created and epithelized in the 2nd/3rd tracheal space. Re-intubation. Subsequent PEG placement: insertion into the stomach. After diaphanoscopy, insertion of a 15 mm stomach wall tube without complications. This is then fixed in the typical manner. Subsequent laser resection: tumor can be adjusted. The tumor is successively cut around on all sides with the laser at a distance of at least 1 cm. The caudal base of the tongue and a large part of the arytenoid fold on the right, the entire vallecula area, the entire epiglottis and arytenoid fold on the left are partially removed. Tumor is thread-marked. Resection also extended to the pre-epiglottic soft tissue, which was also partially removed. Subsequently, a marginal specimen from the caudal-basal area with epiglottis pedicle and soft tissue towards the pre-epiglottis. Subsequently, soft tissues of the vallecula. Both extend from left to right and are marked with sutures. In the frozen section, tumor preparation as well as marginal samples in healthy tissue, thus R0 resection. Now careful hemostasis. Removal of all swabs. Removal of the mouthguard and removal of the spreading laryngoscope. Subsequent repositioning for neck dissection: first disinfect the skin, inject a total of 10 ml Ultracaine 1% with adrenaline into both sides of the neck. Sterile draping. Start with neck dissection on the left: Skin incision in typical manner. Exposure of digastric muscle, omohyoid muscle, sternocleidomastoid muscle. Subsequent exposure of facial vein, internal jugular vein, carotid artery, vagus nerve, hypoglossal nerve, accessorius nerve and border cord. Level II to V evacuation with exposure and preservation of the above structures and exposure and preservation of the branches of the cervical plexus. Subsequent operation on the right side: in principle the same procedure here. Positive lymph node clearly in level IV. Overall removal of levels II to V with dissection and preservation of the structures as on the opposite side. Subsequently, careful hemostasis and irrigation with H2O2 and Ringer's solution on both sides. No more bleeding on final inspection. Wound closure in layers on both sides and insertion of a Redon drain. Re-intubation and insertion of an 8-gauge tracheostomy tube. Overall cT2 to 3 squamous cell carcinoma of the vallecula or epiglottis and supraglottic area. Positive lymph node on the right. PEG tract loosening after 24 hours in a typical manner. Then initially nutrition via PEG. Continue antibiotics for a total of 2 days postoperatively with Unacid. At least temporary dysphagia to be expected, therefore early swallowing training, if necessary presentation to swallowing rehab. With regard to the further therapeutic procedure, wait for the final histology and presentation at the interdisciplinary tumor conference.