After induction of anesthesia and preparation of the patient by the anesthesia colleagues, a pharyngoscopy is first performed to determine the current extent of the tumor. As described above, the tumor was found to be a superficial exophytic process in the area of the upper right tonsil lobe, beginning to grow uvularly. The base of the uvula is clearly infiltrating and also growing over the left posterior palatal arch towards the left tonsil. In addition, there are wide, island-like suspicious findings distributed over the soft palate, some of which could already be confirmed as invasive carcinoma in the panendoscopy, partly leukoplakic, partly exophytic mucosal changes, which are primarily located at the mucosal level. First of all, the PEG was inserted. For this purpose, insertion with the gastroscope under laryngoscopic control. Easy to see through to the stomach. If diaphanoscopy is good, the stomach can be punctured and the PEG tube inserted using the usual suture pull-through method. The patient is then prepared for definitive resection. Transenorally, first turn to tumor resection. Cutting around the tumor process with the electric needle, later using the dissection technique. The right tonsil is resected in the sense of a radical tonsillectomy. The resection reveals suspicious changes at the mucosal level, including large areas of the posterior palatal arch, which is therefore completely resected up to the posterior pharyngeal wall. Subtotal resection of the soft palate, here partly nodular changes in the area of the mucosa, but no dorsal wall penetration. Tonsillectomy is performed here due to the growth just before the left tonsil. In addition, the tumor is removed and resected en bloc to the extent described. The tumor is now completely imaged at the mucosal level with marginal samples, which are diagnosed in the frozen section diagnostics as completely free of tumor and dysplasia with a clear R0 situation. The graft is now measured with configuration for almost complete replacement of the soft palate and tonsil lobe. The neck dissection and elevation of the radialis graft are now performed in staggered fashion. First turn to the neck dissection of the left side. Here the skin incision is made at the anterior edge of the sternocleidomastoid muscle, curved. Cut through the skin and subcutaneous tissue. Exposure and transection of the platysma, exposure of the sternocleidomastoid muscle, omohyoid muscle and gastric muscle after exposure of the submandibular gland. Dissection of the anterior neck preparation with exposure and protection of the cervical artery, the superior thyroid artery, the facial vein and the hypoglossal nerve. Dissection of the internal jugular vein, visualization of the accessorius nerve. Numerous nodules of somewhat conspicuous size can be seen in the course of the vein, but without infiltrative growth. Clearing of the accessorius triangle with careful protection of the nerve. Subsequent evacuation of level V with careful protection of the cervical plexus branches. Caudal check for lymphatic dryness. Careful inspection and palpation of all wound cavities and surfaces, followed by wound irrigation and insertion of a 10-gauge Redon drain and careful two-layer wound closure. Then turn to the opposite side. The procedure is basically the same here. Curved skin incision on the anterior edge of the sternocleidomastoid muscle. Cut through the skin and subcutaneous tissue. Exposure and transection of the platyma. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the digasatric muscle. Release of the anterior neck preparation with careful protection of the superior thyroid artery, the cervical sinus, the hypoglossal nerve and the facial vein in the region of the neck. Exposure of the accessorius nerve. Clearing of the accessorius triangle with careful protection of the nerve. Subsequent evacuation of level V with careful protection of the cervical plexus branches. Here too, in the area of the vein course, several nodules, somewhat conspicuous in number and size, without definite malignancy criteria. This is followed by transection and resection of the venter anterior digastric muscle, exposure of the styloid and performance of the pharyngotomy, partial resection and opening of the musculature and creation of a sufficient tunnel for displacement of the pedicle. Now to lift the radialis graft. The patient had a chainsaw injury with reconstruction of the hand, but the radial artery had already been correctly positioned preoperatively. No scarring along the course here either. Marking of the graft in a special configuration. Performing the graft elevation in bloodlessness. Incision of the graft. Exposure of the cephalic vein. Perform the Haydn maneuver to identify the superficial ramus, radial nerve, which must be partially removed in the area of a transverse hand arch. The main trunk can be preserved. Identification of the distal vascular pedicle. Separation after ligation. Ulnar dissection with exposure of the flexor carpi ulnaris. Strict superfacial release of the graft. Dissection of the pedicle including the cephalic vein. Exposure of the radial artery, very high exit of the ulnar artery. Exposure of the common interosseous artery, which is spared. Exposure of the venous bridge to the........ system. Therefore, use the cephalic vein for subsequent anastomosis. Reopening of the vena cava. Regular and complete hand perfusion and excellent graft perfusion are immediately apparent. After careful hemostasis, placement of the graft, later careful two-layer wound closure with incorporation of the full-thickness skin lifted from the right groin. Subsequent application of the vacuum pump and placement of the Cramer splint in the functional site with subsequent repositioning of the arm. Full-thickness skin removal from the right groin. To do this, cut around a piece of skin measuring approx. 12 x 5 cm, strictly cutaneous lifting. Subcutaneous mobilization afterwards. Insertion of a 10-gauge Redon drain and, if the wound was dry, strong and multi-layered wound closure. The graft was incorporated at the same time. Good fit with intact conditions on all sides. Pedicle positioning and conditioning. Conditioning of the superior thyroid artery and facial artery. Performing the arterial anastomosis with 8.0 Ethilon, this is considerably more difficult due to the caliber and difference, but is ultimately successful with immediate regular venous return. Measuring a size 3.5 coupler and performing a venous anastomosis with the coupler. Subsequently, regular perfusion and pulsation with excellent enoral flap perfusion. Postoperatively, please abstain from food for 7 days, then gradually build up the diet. Intraoperative R0 resected cT3 oral cavity carcinoma. Extension of adjuvant therapy depending on lymph node status.