This is followed by pharyngoscopy and laryngoscopy: The tumorous process is visible, which extends from the left pharyngoepiglottic plica over the base of the tongue and vallecula area to the midline to the right by about 1 cm. Involvement of the vallecula, the left epiglottis and the caudal base of the tongue. Deep tumor crater to the left. Laser resection now follows: positioning of the tumor with a spreading laryngoscope. The tumor is removed macroscopically at a distance of approx. 1 cm on all sides in healthy tissue. Resection extends from the right paramedian to the left just below the tonsil lobe. The entire base of the tongue is resected caudally and the hyoid bone is exposed, almost over the entire plane. Complete vallecular resection, resection of the left mucosa of the epiglottis except for a small region just in front of the point of envelope. The specimen is removed, thread-marked and sent for frozen section. In addition, a wide mass from the entire cranial region is sent in. The specimen is relatively scarce in the cranial direction, but is well covered by the cranial margin specimen, which is healthy. Tumor cells are still scattered laterally to the right and especially caudally to the right. However, intraepithelial lymphangiosis is also detectable towards the depth. Therefore another resection to the right, very carefully so as not to damage the lingual artery. The left lingual artery had already been closed with clips. Resection of this 1 cm wide strip with underlying soft tissue now follows. Resection extends from right lateral cranial to right lateral caudal, including the lateral parts of the epiglottis. Strip is sent in, no more tumor infiltrates here. Thus an overall R0 situation. Careful hemostasis is now performed. Resection was performed using a 5-6 watt superpulse laser. The patient is now transferred for modified radical neck dissection and tracheostomy. First decision to insert a PEG tube in the typical manner. This is done without complications using the suture pull-through method with adequate diaphanoscopy. A neck dissection is then performed on the right side. Creation of a skin incision along the anterior edge of the sternocleidomastoid muscle. Cut through the skin and subcutaneous tissue. Dissection of the platysma. Exposure of the anterior border of the sternocleidomastoid muscle. Exposure in the depth of the nervus accessorius, the omohyoid muscle and the digaster muscle. Dissection of the above-mentioned structures revealed several highly visible masses in regions II to V b, partly with the sternocleidomastoid muscle caudally with the omohyoid muscle, especially the masses in regions IV and V b were broadly adjacent to the internal jugular vein. First attempt to dissect along the cervical vascular sheath. Difficult dissection, scarred conditions. Exposure and protection of the vagus nerve and the common carotid artery. Removal of the posterior neck specimen together with the highly suspicious mass in regions II to IV while sparing the above-mentioned structures. Removal of fibers of the sternocleidomastoid muscle in the neck preparation. Hemostasis using bipolar coagulation. Protection of the deep plexus branches. Then concentrate on the highly suspicious mass in regions IV and V b. Dissection of the omohyoid muscle. Inclusion of fibers of the omohyoid muscle in the preparation. Heavily scarred conditions. It is then possible to first find a layer on the internal jugular vein and then to detach the large conglomerate of Regio IV and V b from the internal jugular vein. Hemostasis using bipolar coagulation. Subsequent removal of the anterior neck specimen. Hemostasis using bipolar coagulation. Wound irrigation using hydrogen peroxide and Ringer's solution. Placement of a 10 Redon drain. Two-layer wound closure. Now repositioning of the patient to perform a neck dissection on the left side. Sonographic cN3 neck status with a large mass over 6 cm in regions II and III and two small, highly suspicious masses, cystically altered, in regions IV and V b. Creation of a skin incision along the anterior edge of the sternocleidomastoid muscle. Cut through the skin, the subcutaneous tissue and the platysma. Expose and dissect along the anterior border of the sternocleidomastoid muscle. In this step, the N3 metastasis in regions II and III is already encountered, which appears cystically altered. Dissection along this mass in regions II and III, exposing the posterior belly of the digastric muscle and the capsule of the submandibular gland, which is removed from the specimen. Inclusion of fibers of the sternocleidomastoid muscle in the preparation. The nervus accessorius cannot be preserved due to clear infiltration and is removed with the preparation. Subcutaneous tissue from region V and muscle fibers of the scalene muscles are included in the preparation. Hemostasis using bipolar coagulation. Subsequent dissection from cranial to caudal. Removal of the neck specimen together with the highly suspicious mass in region IV. Very careful, laborious dissection in region V b. Removal of the neck specimen in toto. Extensive hemostasis in region V b using bipolar coagulation. Exposure and protection of the neck vessel sheath. Extremely difficult dissection in region V b. This results in a small tear in the internal jugular vein, which is immediately treated using Vascufil suture 6-0. Removal of the anterior neck specimen. Hemostasis using bipolar coagulation. Placement of a 10 Redon drain and two-layer wound closure and completion of the neck dissection on the left side. Due to the large wound area ..... and the left vallecula and the expected pronounced dysphagia, the decision was made to perform a tracheostomy in the typical manner. Creation of a skin incision directly below the level of the cricoid cartilage, approx. 3 cm long. Cut through the subcutaneous tissue. Exposure of the prelaryngeal musculature. Exposure of the anterior wall of the thyroid isthmus. Undermining of the thyroid isthmus using Pean clamps. Separation of the thyroid isthmus and ligation of both thyroid stumps. Exposure of the anterior wall of the trachea. Creation of a tracheal incision between the 2nd and 3rd tracheal cartilage clasp. Creation of a Björk flap in the typical manner and epithelialization of the tracheostoma. Reintubation to a size 8 Rügheim tracheostomy tube. Completion of the procedure without complications. Transfer of the patient to the intensive care unit. Feeding for at least 1 week via PEG tube, then cautious diet build-up. Due to the overall situation, postoperative RCT should certainly be discussed in the interdisciplinary tumor conference.