First, laryngoscopy and pharyngoscopy again: insertion of the mouth guard and insertion of the Kleinsasser tube size 10, the larynx is difficult to adjust. The exophytic tumor is seen, which does not quite reach the arytenoid region on the right and extends into the morgue sinus on the right and forward into the anterior commissure and from there into the left side. A tracheoscopy was performed beforehand. This showed no relevant growth towards the subglottic region. Subsequently, partial laryngectomy. Therefore, procedure now confirmed from the outside. This is followed by repositioning, surgery from the outside. Injection not possible due to age and previous illness. This is followed by the creation of an apron flap in a typical subplatysmal manner. In the case of adhesions on the right and after carotid TEA, this is much more difficult on this side. Then expose the larynx. Splitting of the infrahoyidal musculature. The perichondrium is now dissected from the left side and left undissected on the right side. Exposure of the thyroid cartilage. Splitting of the thyroid cartilage in the middle with a slightly protruding edge to the left. Entering the larynx. Exposure of the tumor. As described, this can be seen growing from the right over the commissure to the left up to half of the vocal fold on the left, also here growth in the direction of the morgue sinus. A triangle of the thyroid cartilage is resected in the front, the perichondrium is dissected away from the cartilage on both sides. The resection includes the pouch ligament on both sides and all soft tissue up to the cartilage. Resection extends as far as the arytenoid cartilage, which can, however, be almost completely preserved. On the left, the resection also extends to a few mm in front of the arytenoid cartilage. Caudally, the resection includes soft tissue up to the ligamentum conicum. Cranially in front up to the petiolus. Removal of the tumor. Removal of marginal samples from the arytenoid region on both sides, caudally on both sides, cranially supraglottically on both sides and in the subglottic direction at the border to the ligamentum conicum as an anterior marginal sample. All marginal samples free in the frozen section, thus R0 situation. Now irrigation of the wound area and careful hemostasis. Readaptation of the remaining thyroid cartilage despite losses on the left side at ......... Cartilage well possible after making 3 drill holes. A total of 3 Vicryl single-button sutures with stable adaptation were performed. The remaining perichondrium is wrapped around the thyroid cartilage again and sutured to the opposite side. The ligamentum conicum is also sutured and the perichondrium is sutured there so that a stable and complete closure is achieved. The infrahyoid musculature is then adapted. A tracheostomy had already been performed before the resection. Difficult anatomical conditions with a short neck overall and a relatively deep larynx and trachea. The thyroid gland is shown in the middle of the isthmus area. Undercut and clamped, severed and supplied with puncture ligatures. Trachea is exposed. Entering the 2nd/3rd intercartilaginous space. Creation of a wide pedicled modified Björk flap. Skin mobilization up to the prethoracic skin is necessary to achieve a relatively low-tension medialization of the stoma. Re-intubation and insertion of a laryngectomy tube. Due to the extent of the tumor, indication for selective neck dissection on both sides: start with the right side. Extremely scarred conditions here following carotid TEA. Difficult visualization of the cervical vascular sheath through the scar plates. Exposure of the internal jugular vein. Visualization of the common carotid artery, visualization of a clear kinking which extends towards the paralaryngeal area and the floor of the mouth. Exposure of the vagus nerve, hypoglossal nerve and accessorius nerve. Level II-IV evacuation follows. Branches of the cervical plexus are exposed and preserved. Neck dissection on the left side follows. Level II-IV evacuation in the same way as on the right side. The fatty tissue in front of the head skeleton is also removed as a level VI resection. Subsequent careful hemostasis on both sides. Wound closure in layers with insertion of a Redondra ring on both sides and epithelialization of the tracheostoma. Re-intubation and insertion of an 8-gauge tracheostomy tube. Completion of the procedure without complications. Overall extensive modified frontolateral partial laryngectomy according to Leroux Robert. Both arytenoid cartilages are almost completely intact on the right and completely intact on the left. Nutrition for a few days via the inserted feeding tube. After stabilization, attempted swallowing and, if necessary, swallowing training and, if necessary, diet build-up. In principle, given the extent of the tumor and the borderline resection situation, a control MLE in 8-12 weeks should be discussed. This can be combined with tracheostoma closure if necessary.