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In response to Endoscope‐assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial

We would like to thank Dr. Satvinder Singh Bakshi for his thoughtful comments concerning our article “Endoscopy-assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial.” Recurrence after removal of a thyroglossal duct cyst (TGDC) is a persistent concern. The transoral approach that we have reported remains to be validated, and ongoing studies will be needed to determine the results over the long term. Nevertheless, we feel that it offers some advantages over traditional approach for removing a TGDC, which not only presents a cosmetic problem but also is associated with greater risk for recurrence. Because the transoral approach passes through the avascular space between the genioglossus, one can locate the thyroid remnant tract, which runs from the foramen cecum to the hyoid bone, more easily find than with other approaches. Traditionally, TGDC tends to recur when this tract is not completely excised. The transoral approach successfully removes the TGDC in its entirety, including the thyroid remnant tract, as can be seen in the pathological specimen shown in Figure 1. However, many authors have suggested that the presence of this vestigial tract does not play an etiological role in the recurrence of TGDC. Histological studies have been performed to elucidate the common routes of the thyroglossal duct around the hyoid bone. In the majority of cases, the duct arborizes, extending into many branches, and forms duplicate ducts around the hyoid bone. If not enough tissue surrounding the main duct is excised, many of these arborizing branches will be left behind, and the cyst may therefore recur. In keeping with this concept, we have tried to widen the area of excision when removing the TGDC. In our study, postoperative follow-up has been only 24 months—not long enough to ensure a recurrence-free outcome; nevertheless, we can report no noteworthy recurrences or complications in our present series. More cases will need to accumulate before these encouraging results and long-term stability can be confirmed. In conclusion, excision of a TGDC by the transoral approach not only offers a cosmetic benefit but facilitates removal of the thyroid remnant tract. Thus, this approach, which involves a frenotomy, could be a valuable alternative to the traditional procedure.