After enoral inspection and confirmation of the extent of the tumor, transoral resection is performed after exposure of the tumor as described above on the dorsal right edge of the tongue with transition and infiltration of the glossotonsillar groove. Cut around the tumor from a safety distance of 1.5 to 2 cm, especially in the area inside the tongue. Dorsal resection up to just below the midline, no deep or more extensive infiltration in the area of the base of the tongue. However, poor overview here. Partial resection of the posterior floor of the mouth. Exposure of the submandibular gland, but no infiltration here, but tumor cones behind the gland in depth. Therefore, after resection of the enoral part, including the right-sided tonsil and resection of the glossotonsillar groove, the decision was made to proceed transcervically. For this purpose, submandibular incision and cervical separation of skin and subcutaneous tissue. Separation and dissection of the platysma. Exposure and preservation of the external jugular vein and auricular nerve. Exposure of the sternocleidomastoid muscle, omohyoid muscle. Exposure of the submandibular gland and digastric muscle. First perform the neck dissection. Clear out the anterior neck preparation, carefully preserving the superior thyroid artery, the cervical artery, the facial vein and the hypoglossal nerve. Free preparation of the internal jugular vein, visualization of the accessorius nerve, clearing of the accessorius triangle and clearing of level V with careful protection of the cervical plexus branches. Macroscopically, no suspicious nodules on the right cervical side. Now release the submandibular gland and complete level Ib. Enter via the posterior floor of the mouth enorally. Separation of the digastric muscle, widening of the access to the enoral side, step-by-step good overview of the tumor and taking along circumscribed muscles of the floor of the mouth as the tumor cone grows. Resection of the tumor transcervically in toto. The specimen shows a clear safety margin on all sides, especially in the area deep to the tongue. Only in the area of the glossotonsillar groove and the posterior floor of the mouth is there a safety margin of approx. 1 cm on the specimen, otherwise significantly more. It was therefore decided to take marginal samples in this area. Taking marginal samples from the preparation. In the frozen section diagnostics, these are free of dysplasia and tumor, so that a safe R0 resection can be assumed here. With a tumor measuring an average of 4 cm on the specimen, a cT2 extension is clinically just present. Measure the defect of the posterior floor of the mouth, the edge of the tongue, the base of the tongue and the tonsil lobe. Neck dissection of the left side is then performed first. Here also submandibular incision. Separation of skin and subcutaneous tissue. Exposure and preservation of the external jugular vein, exposure of the limiting musculature. Clearing of levels II to IV with careful preservation of the superior thyroid artery, the facial vein, the cervical artery, the hypoglossal nerve, the accessory nerve and the internal jugular vein. No macroscopically conspicuous nodules here either. Inclusion of the caudal capsule of the submandibular gland. Finally, careful wound irrigation with Ringer's solution and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Perform a plastic tracheostomy. Horizontal incision below the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure 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 insertion of the tracheostoma in the usual manner. Subsequent problem-free transfer to a size 8 low cuff cannula which is suture-fixed. Now to cover the defect. Elevation of the ALT from the right, here after doppler sonographic identification of the main perforator and two secondary perforators. Marking of the graft measuring 11 x 6 cm in total. Medial incision. Cutting through the fascia lata. Reliable identification of the rectus femoris muscle. Subfascial release. Identification of the pedicle vessel. Subsequent identification of the main perforator. Successive free preparation of the main perforator in the sense of a perforator flap. Isolation to the strong pedicle vessel. The sonographically identified secondary perforators are branches of the main perforator. Therefore, take along the main perforator, take along parts of the fascia lata, otherwise cut around the graft. Isolation on perforator and pedicle vessel. Conditioning of the pedicle vessels, elevation of a strong accompanying vein as well as a narrower second vein, and placement of the properly vital graft after the supply and return vessels have been treated. Careful wound inspection and, if the wound is dry, insertion of a 10-gauge Redon drain and careful two-layer wound closure. Subsequent successive incorporation of the graft from the enoral and transcervical sides. This finally succeeds sufficiently with a good fit. Conditioning of the superior thyroid artery. Performing the arterial anastomosis with 8-0 Ethilon, this is sufficient and successful. Immediate regular venous return via the main vein. No flow via the second vein. Therefore occlusion of the vein. Conditioning of the superior thyroid vein. Measuring a coupler size 3.0 and performing the anastomosis with the coupler system. Subsequently, regular graft perfusion, regular pedicle pulsation and positive spreading phenomenon. Subsequent careful wound inspection and, if the wound is dry, insertion of a 10-gauge Redon drain. Positioning of the drain and careful two-layer wound closure and completion of the procedure without any indication of complications. Conclusion: Intraoperative R0 resected at least cT2 cN0 tongue margin carcinoma on the right. The patient received intraoperative intravenous antibiotics with Unacid 3 g, which should be continued for 24 hours postoperatively. If the enoral graft heals properly, attempt to swallow and gradually build up the diet from the 7th postoperative day.