After active patient identification, the patient is brought into the operating theater. Carrying out the team time-out. Introductory consultation with the anesthesiologist. Induction of anesthesia and intubation of the patient. Positioning of the patient by the surgeon. Start of lymph node extirpation. Palpatory identification of the conglomerate of nodes. Infiltration anesthesia is then performed after skin spray disinfection. Ablation of the surgical site. Sterile draping. Marking of the mandibular arch and the ascending mandibular branch. Mark the planned incision from the infralobular, laterocaudal, curved bayonet shape. Cut sharply through the cutis and subcutis. Dissection of the platysma. Dissection of the sternocleidomastoid muscle. Exposure of the lymph node conglomerate. This lies lateral to the cervical vascular sheath. Cranially, the mass is directly adjacent to the accessorius nerve. Medially, the conglomerate extends to just before the hypoglossal nerve. Exposure, displacement and, at the end of the operation, re-embedding of the accessory nerve and hypoglossal nerve in the sense of a neurolysis. Exposure of the internal jugular vein. Successive dissection of the conglomerate. Sending it for frozen section diagnostics. During the frozen section diagnosis by telephone, a squamous cell carcinoma is suspected. Therefore complete the neck dissection. Exposure of the posterior digastric venter muscle as the cranial border. Insertion of the retractors. Exposure of the internal jugular vein including the venous angle. Exposure of the common carotid artery and the bifurcation. Successive development of the lateral neck preparation with careful protection of the accessorius nerve and the plexus branches. With the exception of a small nodule in level III, there are no other suspicious nodules. Turning to the medial neck preparation. Here, too, no further suspicious nodes were found. As the intraparenchymal nodules located in the caudal parotid pole have already appeared sonographically constant for years, a further procedure is deliberately omitted here. Neuro-monitoring is used at the end of the operation to check the integrity of the accessory nerve and the hypoglossal nerve. The oral branch did not have to be visualized intraoperatively. Hemostasis using bipolar coagulation. Wound irrigation with H2O2 and Ringer's solution. Insertion of a 10-gauge redon drain. Subcutaneous suture with Vicryl 4-0 and skin suture with Ethilon 5-0. Application of a pressure bandage. Transition to panendoscopy. First positioning of the patient in head reclination. Insertion of the mouth guard. Enter with the size C small bore tube. First inspect the endolarynx. This appears unremarkable. Inspection of the piriform sinus. This is lined on both sides by smooth mucosa on all sides and can be freely unfolded up to the tip. The same applies to the postcricoid region and the esophageal entrance. A small retention cyst can be seen in the area of the vallecula on the left side. This is marsupialized. However, there is no evidence of malignancy here. This also applies to the base of the tongue and the corpus of the tongue. There is also no evidence of a tumor in the area of the oral cavity or the oral vestibule. Proceed to esophagogastroscopy. Insertion of the flexible endoscope under visualization and constant air insufflation into the stomach. A typical gastric mucosal relief can be seen on all sides. Inversion and inspection of the gastroesophageal junction. This also appears unremarkable. After desufflation, slow withdrawal of the endoscope with circular inspection of all sections of the esophagus. Here too, there is no evidence of malignancy. Removal of the flexible endoscope. First insertion of the McIvor oral spatula. Inspection of the left tonsil. A primarily suspicious area can be seen in the depth of the crypts just below the upper tonsil pole. If it is suspected that this could be the primary, the tumor tonsillectomy is now performed with the necessary safety margin. For this purpose, a parauvular incision and resection of the left tonsil including parts of the anterior and posterior palatal arch is performed first. Lateral dissection is performed up to the parapharyngeal fatty tissue. Exposure of the lower tonsil pole. The suture is marked before the tonsil is removed. Sending the tonsil for frozen section diagnostics. In the meantime, hemostasis is performed. During the frozen section diagnosis by telephone, an R0 resected tonsil carcinoma is found in the area of the left tonsil. A mucosoplasty is performed. With a dry wound bed, the operation is now completed without complications. Final consultation with the anesthesiologist.