First inspection of the primary tumor region. The largely submucosal mass of the right edge of the tongue can be seen, largely as described above, the tip of the tongue is free, measuring a total of approx. 4 cm, some progression towards the lateral floor of the mouth, here too largely submucosal tumor parts, the base of the tongue itself is free dorsally, tumor formation is well displaceable in the tissue. Transoral tumor resection is performed first. Cutting around the tumor process with the monopolar needle or using the dissection technique while maintaining an adequate safety distance in the sense of a hemiglossectomy. Removal of the entire lateral floor of the mouth. Exposure and exposure of the submandibular gland, which itself is not infiltrated. Clear transition to the lateral floor of the mouth, but the tumor is limited to one side without infiltration of the base of the tongue or anterior floor of the mouth. In frozen section diagnostics, the tumor appears to be removed in sano on all sides. Only in the area of the lateral floor of the mouth, towards the depth, are the in sano conditions scarce. For this reason, a completely covering resection was carried out later, which led to definitive histology. In the meantime, endoscopic PEG placement was also performed. This involved insertion with the gastroscope under laryngoscopic control. Easy to see through to the stomach. Here, with good diaphanoscopy, problem-free puncture of the stomach. Subsequent placement of the PEG tube using the usual thread pull-through method. Repositioning of the patient and turning to the neck dissection on the right side. Submandibular extended incision. Dissection of skin and subcutaneous tissue. Dissection of the platysma. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland and digastric muscle. Clearing out the anterior neck preparation while carefully protecting the facial vein, superior thyroid artery and hypoglossal nerve. In the area of the jugulo-facial angle, a somewhat coarse change is seen, measuring approx. 1 cm, here macroscopically unclear conditions, otherwise no abnormalities on sonographic cN0 neck status. Exposure of the accessorius nerve, clearing of the accessorius triangle and completion of level V a with careful protection of the cervical plexus branches. Subsequent mobilization and removal of the submandibular gland, completion of level I b and removal of the right-sided level I a. Separation of the digastric muscle. Enter enorally and create a tunnel measuring 3 transverse fingers. Subsequent careful hemostasis in the neck area. Initially, the external jugular vein and the auricular nerve were also preserved. Due to the cN0 neck status sonographically and the old, multimorbid and extremely obese patient, neck dissection of the opposite side was not performed. Due to the now extensive defect, the indication for defect coverage with a pedicled graft from the right shoulder was made. Measurement of the defect measuring a total of 10 x 6 cm in the area of the right-sided tongue and the floor of the mouth. Marking of the graft including the acromion. Trimming of the graft. Removal of the graft including the muscle fascia. Lifting of a wide pedicle, including the preclavicular tissue. Exposure of the trapezius muscle. Exposure of the clavicle and successive development of the pedicle by tunneling cervically. Due to the adipose conditions, tension-free graft insertion is only possible up to the level of the anterior floor of the mouth while protecting the pedicled tissue. Extremely well vitalized graft. Suturing of the graft with a good fit, only the tip of the tongue is primarily adapted in order to avoid creating increased tension here. Subsequently, intact conditions on all sides. In the shoulder area, subcutaneous mobilization and strong, multi-layer wound closure after insertion of two 10 Redon drains. Subsequent insertion of a 10 Redon drain in the neck area and careful, two-layer wound closure here too. Finally, due to the adipose conditions and increasing swelling, a protective tracheostomy was performed. To do this, make a horizontal incision at the level of the cricoid cartilage. Cut through skin and subcutaneous tissue. Exposure and transection of the infrahyoid musculature. Exposure of the cricoid cartilage. Exposure of the anterior surface of the trachea. Insertion between the 2nd and 3rd tracheal ring, creation of a visor tracheotomy and suturing of the tracheostoma in a typical manner. Subsequent problem-free reintubation to a size 8 low-cuff cannula, which is suture-fixed. Conclusion: Intraoperative R0 resected cT2 cN0 tongue margin carcinoma on the right. If the graft heals properly, a diet can be started from the 7th postoperative day. Due to the patient's age and obesity, recovery of swallowing function may be delayed.