Reclination of the head. Applying the mouth retractor. Exposure of the tumor. Transoral resection: The tumor is incised on all sides with a safety margin of at least 1 to 1.5 cm. The tonsil lobe, anterior palatal arch, mucosa of the glossotonsillar junction and also approx. 25-30% of the right tongue base are removed. The resection extends caudally to the hypopharyngeal entrance. The specimen is thread-marked. After inspection of the tumor specimen, a cranial margin sample is taken from the palatal arch area. Also take a basal-lateral marginal sample from the pharyngeal wall area, behind the tonsillar lobe or in the direction of the glossotonsillar junction. In the frozen section, specimen R0 on all sides, somewhat scarce basally, but now an R0 situation when viewed together with the marginal specimen. Careful hemostasis is performed. During the transoral resection, the lingual artery was stitched and treated with clips. Re-inspection shows clips in situ, no evidence of bleeding. PEG insertion: insertion of the gastroscope. Pre-mirroring into the stomach. After creating a spontaneous diaphanoscopy, insertion of a 15 mm abdominal wall tube in a typical manner without complications. This is also fixed to the abdominal wall in a typical manner. Repositioning for neck dissection on both sides and tracheotomy. First sterile draping after skin disinfection and after injection of a total of 10 ml Ultracaine 1% with adrenaline into both sides of the neck. Beginning with neck dissection on the right: typical skin incision. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid and digastric muscles and infrahyoid muscles. Then exposure of the internal jugular vein, facial vein, internal carotid artery, external carotid artery, submandibular gland, vagus nerve, hypoglossal nerve and accessorius nerve. All structures are preserved. Removal of the larger, clearly malignant suspicious masses as part of the neck preparation. This is followed by a level II to V excision while preserving the branches of the cervical plexus. Finally, careful haemostasis with RZZZ dissolution and layered wound closure with insertion of a Redon drain. Tracheostoma creation: This is performed by <CLINICIAN_NAME>. Small Kocher collar incision. Exposure of subcutaneous tissue and transection of this. Veins are ligated. Exposure of the infrahyoid musculature. This is divided. Exposure of thyroid cartilage and thyroid isthmus. Undercutting of the thyroid isthmus, clamping, severing and treatment using puncture ligatures. Subsequent exposure of the trachea. Finally, creation of a broadly pedicled modified Björ flap. This is epithelized in a typical manner. Insertion of a 7 mm tracheal cannula. Neck dissection is then performed on the left through <CLINICIAN_NAME> and <CLINICIAN_NAME>. Dictation <CLINICIAN_NAME>: Marking of the skin incision and careful skin incision and dissection of the subcutaneous fatty tissue. Cut through the platysma and bluntly push the platysma away from the cervical fascia. Start dissection with the sternocleidomastoid muscle. Here the anterior margin is sought out and carefully dissected from the center of the muscle caudally (region IV). This reveals the omohyoid muscle, on whose muscle belly the dissection is carried out further cranially. Sharp dissection of the submandibular gland and elevation of the gland. Below the gland, the digaster muscle is now sought out and followed in the direction of the mastoid. This is done by means of blunt dissection and with protection of the facial vein. Locate the triangle between the omohyoid muscle and the submandibular gland. Clearing out the neck preparation. Careful preliminary work laterally on the omohyoid muscle and medially on the internal jugular vein in order to clear the medial neck preparation. This is achieved without any problems. Move on to the lateral compartment. Here the jugulofacial angle is carefully exposed. Below the vein, the hypoglossal nerve can be seen, which is exposed approx. 1 cm wide and can be spared without any problems. Continue laterally to the upper part of the sternocleidomastoid. The accessorius nerve is located here. Spread in the direction of the nerve and locate the nerve. This is spared. Now continue preparation with level IIb. Here, bipolar coagulation and sharp dissection of the sternocleidomastoid muscle and the digaster to region IIb is performed and the preparation is pulled through under the accessorius nerve. Further dissection caudally at the internal jugular vein. The common carotid artery is also exposed and the vagus nerve is visualized. This is done without any problems and both structures can be spared. Now continue dissection of the lateral compartment from cranial to caudal. The caudal border is defined as the omohyoid muscle, the deep border as the plexus branches. All these structures can be spared. After completion of the dissection of the lateral compartment, there is no evidence of a chyle fistula. The cervical sinus could not be spared. After careful hemostasis with bipolar coagulation, irrigation with H2O2 and Ringer. Insertion of a drain ( 10 ) and two-layer wound closure. Subsequent re-inspection of the wound surface intraorally after insertion of the McIvor spatula. Small areas of mucosal bleeding are still visible. These are stopped. No further bleeding. Stable vascular situation in the area of the clips. Due to the somewhat more extensive resection, exposure and ligation of the lingual artery from the cervical side was omitted, as there would otherwise have been a risk of a fistula. Stable situation at check-up, no bleeding. Completion of the procedure without complications. The patient is admitted to the intensive care unit for postoperative monitoring. Please feed via the PEG system due to the extensive transoral resection. Please continue antibiotics for one week with Unacid, which was given intraoperatively. Overall cT2 cN2b tonsillar carcinoma. Radiotherapy or radiochemotherapy indicated depending on the postoperative findings.