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Figure 3. Intraoperative image. After performing tracheotomy, double functional bilateral neck dissection, excision of the lesion with macroscopic margins above the centimeter and subsequent reconstruction with radial forearm flap was performed. Histological results reveals a pT3N0M0 human papillomavirus 16+ squamous cell carcinoma, with close resection margins, 6 mm thickness, with no vascular or perineural infiltration. After surgery, the patient received adjuvant radiotherapy. She is currently without signs of loco-regional recurrence