Pharyngoscopy and laryngoscopy are now performed again: No significant changes to the previous findings. In the area of the lower lip on the left, a suspicious leukoplakia mass was found. This was removed superficially and sent in as a final marginal sample. Post-resection of in situ carcinoma of the vocal fold on the right using a CO2 laser: All of the remaining teeth in the anterior region are no longer completely fixed. Incisors and premolar tooth on the left appear decayed. Pin tooth on the right also somewhat loosened. Adjustment is made with the size C small water pipe. The epithelium is resected under visualization while preserving the vocalis muscle. The entire specimen is sent in marked with a thread. No further tumor infiltrates in the frozen section, so that there is an R situation here. Subsequent resection of the alveolar ridge carcinoma on the right side: The previously described cT1 tumor is resected on all sides with a safety margin of at least 0.5 cm to 1 cm, macroscopically clearly within the healthy tissue. This results in a defect in the anterior palatal arch and on the alveolar ridge, with periosteum remaining here. The preparation is sent in as a complete preparation for frozen section diagnostics. Infiltrates still present in the anterior region towards the floor of the mouth and posteriorly towards the palatal arch. Therefore, another resection of at least 5 mm and a marginal sample of approx. 2 mm in width is made semicircularly from the front and back. In the frozen section specimens this time still mild to moderate dysplasia, but no more carcinoma in situ. R0 resection therefore also in the alveolar ridge area. Laser resection of the oro/hypopharyngeal carcinoma on the right is now performed: the patient's adjustability is approximately suboptimal. During adjustment, the remaining premolar tooth on the left, which is decayed, is loosened and can be removed without difficulty. The carcinoma is then successively resected in a preparation with the CO2 laser cw, super pulse and 4 to 5 watts. The result is a resection of the lower tonsil pole of the lower lateral pharyngeal wall, whereby the resection extends to the middle to the beginning of the posterior hypopharyngeal wall and laterally over the base of the tongue and vallecula area into the supragottic area. There, a large part of the aryepiglottic fold is resected away, whereby the resection also extends into the supraglottic area up to the vicinity of the pocket fold. The entrance to the piriform sinus is resected caudally up to the middle of the piriform sinus. The resection is performed basally while preserving a muscle layer. The specimen is marked with sutures (long/long=caudal piriform sinus; long/short=medial aryepigl. Fold medial; short/short=pharyngeal wall medial using blue suture and green suture: short/short=base of tongue; short/long=pharyngeal wall lateral and long/long: pharyngeal wall cranial tonsil. In the frozen section, there are still in situ tumor infiltrates in the caudal area towards the piriform sinus. Therefore, a wide resection of an almost 1 cm wide strip from the piriform sinus caudally, extending over the postcricoid area to the arytenoid cartilage, is performed again using a laser. This is followed by another conventional resection of a strip of mucosa several mm wide. This mucosal strip is sent in again for a frozen section. Despite extensive resection, focal in situ infiltrates in the lateral area of the hypopharynx are still visible in the final marginal specimen. The resection extended into the tip of the hypopharynx. The arytenoid cartilage and postcricoid area in the paramedian right and left areas were well preserved mucosally; the mucosa was almost completely missing on the right side. Due to the extent and the fact that a total of 3 tumors are present and there is multicentric tumor growth, no further resection is performed here. Prior to tumor resection, a PEG was inserted into the stomach using a flexible esophagoscope. There, under visualization, insertion of a 9 mm abdominal wall tube in the typical manner without complications. Fix it to the abdominal wall. Then selective neck dissection on both sides: same procedure on both sides. First neck dissection on the right: skin incision in a typical manner along the sternocleidomastoid muscle. Subsequent exposure of the muscle, exposure of the omohyoid muscle, exposure of the digastric muscle. Exposure of the cervical vascular sheath, internal jugular vein, external/internal carotid artery, vagus nerve, accessorius nerve. Development of the dorsal neck preparation while preserving the cervical plexus. Subsequent development of the anterior neck preparation, exposing and preserving the hypoglossal nerve, superior thyroid artery and cervical nerve. Overall, level II to V were removed due to the multiple tumors. Neck dissection on the left side was performed in the same way. Here, after hemostasis, the wound was closed in layers with the insertion of a Redon drain. Then tracheostoma creation: small Kocher collar incision, dissection through the subcutaneous tissue to the infrahyoid musculature. Spreading of the same. Exposure of the thyroid isthmus. Undercutting of the thyroid gland, clamping and treatment with puncture ligatures. Subsequent exposure of the trachea. A small, visor-like Björk flap is created. This is epithelized in the typical manner. Subsequently reintubation and insertion of a size 8 tracheal cannula. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Total carcinoma in situ, vocal fold R0 situation, alveolar ridge carcinoma cT1-2, R0 situation and oropharyngeal/hypopharyngeal carcinoma involving the supraglottic region - total cT3-4. Due to the number of tumors and the microscopic tumor infiltration in the area of inconspicuous mucosa, it is assumed that the tumor is multicentric. In any case, postoperative radio-chemotherapy is indicated. Nutrition via the inserted PEG tube. After approx. 1 week, a diet can be started. Due to the preserved arytenoid cartilage, there may be a delay in relearning to swallow.