Introductory consultation with the anesthetist. Positioning of the patient and insertion of the mouth guard. An exophytic tumor can be seen, which particularly involves the tonsil on the left side in the area of the middle and lower half of the tonsil and extends to the base of the tongue. The resection begins parauvularly in the area of the anterior and posterior palatal arch. Here resection with the electric needle. Care is taken to ensure a sufficient safety distance of more than 5 mm. The resection is carried out from the cranial to the lateral, into the pharyngeal muscles. Further resection is carried out strictly along the pharyngeal musculature, which in some cases only forms a wafer-thin bridge into the parapharyngeal space. Several larger vascular inflows are partially coagulated here, but also partially cut off. The resection continues towards the caudal tonsil pole. Further dissection along the pharyngeal musculature. It can now be seen that the tumor clearly extends to the base of the tongue. Therefore, the tumor is finally resected macroscopically in toto with a large portion of the base of the tongue. Careful hemostasis. The specimen is thread-marked for histopathological evaluation. In the meantime, a radical neck dissection of the left side of the neck is performed. This was possible due to the continuous musculature of the pharynx, which, although only partially very thin, could be preserved in continuity. The intraoperative frozen section revealed that although the margin of the base of the tongue was R0, it appeared to be very narrow. Therefore, after performing the neck dissection, an additional resection was performed in the area of the base of the tongue. This was performed without any problems. Subtle hemostasis was performed again so that the wound was sufficiently dry at the end of the operation. Neck dissection on the left. Skin incision curved in the typical manner, just below the tip of the mastoid to the level of the omohyoid muscle. Dissection of subcutaneous tissue and platysma. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and exposure of the digastric muscle. A large tumor conglomerate is visible, which is fixed to the sternocleidomastoid muscle and can be mobilized by partially removing the muscle. First visualization of the facial vein, which is ligated. Exposure of the internal jugular vein. The tumor node can be dissected from the jugular vein below it. Exposure of the internal and external carotid arteries and the superior thyroid artery. Exposure, displacement, neurolysis and re-embedding of the following nerves: vagus nerve, hypoglossal nerve, cervical nerve. The accessorius nerve in particular is firmly fused to the tumor conglomerate and can be detached with difficulty, but preserved. All branches of the cervical plexus are also exposed and preserved. The capsule of the submandibular gland was removed caudally. The overall result is an evacuation of levels II to V. Apart from the clear malignancy of the lymph node conglomerate, there are still some lymph nodes in the specimen that appear to be suspicious. Finally, careful irrigation and hemostasis. Wound closure in layers with insertion of a Redon drainage. Application of a pressure dressing. After a positive diaphanoscopy, the PEG is placed using the thread pull-through method. Dressing application. Final consultation with the anesthetist.