Initial inspection of the tonsil region. The tonsils are very small on both sides and rather unremarkable from a macroscopic point of view. A tumor tonsillectomy was performed on the left side due to an abnormal PET-CT finding. Incision of the anterior palatal arch and dissection of the tonsil with removal of some musculature under bipolar coagulation, then sending the tonsil marked with a thread for frozen section. Unfortunately, the pathologist found carcinoma in situ in the area of the anterior palatal arch and medially. These areas will be resected. A large resection is performed on the anterior palatal arch in the mucosal area and also on the posterior palatal arch in the mucosal area and then marginal samples are taken in each case. However, the new marginal samples are then free of tumor and carcinoma in situ. In the meantime, a PEG was performed using the thread pull-through method with <CLINICIAN_NAME> without any problems. Rearrangement for neck dissection, as already mentioned the skin looks very burnt. It almost has the aspect of postradiation skin. A skin incision is made at the anterior edge of the sternocleidomastoid. Palpation reveals a very thick, large mass that already occupies a large part of the sternocleidomastoid muscle. After the skin incision, dissection is extremely difficult as the tissue is sulfurously inflamed, which is due to galvanotherapy. You have to fight your way through thick scar plates and through tissue that bleeds very easily. The sternocleidomastoid muscle is exposed first in the lower and then in the very upper area. A platysmal flap is formed in the posterior and anterior region. The sternocleidomastoid muscle is first released laterally, then an attempt to release it with the laser is unsuccessful. The internal jugular vein is pulled completely into the metastasis, it is ligated above and below and then removed. The internal carotid artery and the vagus nerve can be spared, as can the coronary artery. Then remove the entire neck specimen after separating the sternocleidomastoid muscle in the upper and lower area so that the entire neck specimen can be removed en bloc with thick caked metastases. Intraoperative demonstration on <CLINICIAN_NAME> and <CLINICIAN_NAME>, demonstrating that the metastasis runs directly through the cervical plexus and could not be detached from it. The plexus branches are therefore also removed. Then hemostasis by means of bipolar coagulation and irrigation. During dissection, the lingual artery is torn and must be ligated. If a very radical approach is required, the neck dissection on the opposite side is initially omitted. The oral cavity and oropharynx are then inspected again. A relatively large defect can be seen laterally, where neck fat also emerges at one point. A mucosal flap is therefore formed with the posterior palatal arch to minimize bleeding and the risk of fistula. The patient is admitted to the intensive care unit.