First insertion with the small water tube and inspection of the tumor region. Then insertion of the tonsil plug. It is noticed that there is a suspicious lesion on the posterior pharyngeal wall relatively far cranially in the oropharynx; this is biopsied and sent for a frozen section. This also shows squamous cell carcinoma, which was not previously described. This area is connected submucosally with 2 further suspicious areas that were previously described, 1x in the hypopharynx at the entrance to the piriform sinus and 1x at the transition between the oropharynx and hypopharynx. All these lesions are connected submucosally. Then sterile washing and draping and start with transoral tumor resection. Cut around the tumor with the monopolar needle. Lift off the prevertebral fascia and dissect as far caudally as possible. If the overview is restricted, switch to a transcervical approach. For this purpose, create an apron flap in the usual manner. Expose the cervical vascular sheath. Securing the cervical sheath. Exposure of the left part of the hyoid bone and the superior laryngeal nerve. Expose the pharyngeal muscles and then enter with the small bore tube and determine the site where the pharyngotomy will be performed. It can be seen that the tumor is at the entrance to the piriform sinus and is therefore also partially under the thyroid cartilage. Exposure of the upper horn of the thyroid cartilage and detachment of the piriform sinus from the thyroid cartilage on this side. The upper horn of the thyroid cartilage and a small part of the thyroid cartilage must be resected in order to reach the tumor properly. Then enter the pharynx and resect the tumor with a safety margin of 0.5 to 1 cm. The specimen is placed en bloc on cork and marked for histology. All margins free in the frozen section, i.e. intraoperative R0 situation on the specimen. Measure the defect 12 x 6 cm and mark on the forearm. Start preparation of the radialis graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Exposure of the cephalic vein. Exposure of the brachiocephalic muscle. Showing the venous star in the crook of the elbow. Visualization of the venous confluence. Visualization of the radial superficial ramus nerve. Exposure of the radial artery. Removal of the radial artery. Lifting of the radialis graft from the tendons. Then dissection of the pedicle up to the crook of the elbow. Removal of the pedicle, including 2 deep veins and 1 superficial large cephalic vein. In the meantime, parallel neck dissection on the right side by <CLINICIAN_NAME> and <CLINICIAN_NAME>. After creation of the apron flap by <CLINICIAN_NAME>, perform a neck dissection on the right side Level II to V. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure of the accessorius nerve. Exposure of the omohyoid muscle. Tracing the omohyoid to the hyoid bone. Visualization of the cervical vascular sheath of the internal jugular vein. Exposure of the submandibular gland and the posterior venter of the digaster. The borders are thus shown. Now detach the neck preparation from level II b, II, III, IV and V, preserving all non-lymphatic structures. The vagus nerve and carotid artery are exposed and spared. The accessor nerve is exposed and also spared. The plexus branches are clearly visible in depth and level V is cleared. No evidence of chyle fistula. Left Start of neck dissection by <CLINICIAN_NAME> and takeover of <CLINICIAN_NAME>. Exposure of the cervical vascular sheath after the borders, i.e. sternocleidomastoid, omohyoid, submandibular and accessory gland and digastric muscle, have been exposed. Neck levels II to V were then removed. Plexus branches were spared, hypoglossus spared and accessorius nerve spared, cervical nerve spared. Then suturing of the radialis graft, first from the transoral, then from the transcervical side and removal of the pedicle to the left side. End-to-side anastomosis between the cephalic vein and internal jugular vein and coupler between the facial vein and a deep vein of the radialis graft and anastomosis between the radial artery and facial artery. Insertion of Redon drains, one on each side, and two-layer wound closure. Flap control according to the usual scheme, antibiotics for at least 24 hours.