Reply to letter to the editor regarding course of lingual artery.

To the Editor: We appreciate the comment provided by Gun et al regarding our recently published manuscript. We agree that the digastric and stylohyoid muscles are found lateral to the lingual artery as based on embryologic origins as well as previously described anatomic dissections. We contend, however, that the dissections presented do indeed show the posterior belly of the digastric. The images and figures in our article show the posterior belly of the digastric crossing the lingual artery from lateral to medial. These images were acquired after transecting the attachments to the superior aspect of the hyoid. The digastric muscle consists of an anterior and posterior belly and the tendon between these bellies is attached to the body and greater cornu of the hyoid by the suprahyoid aponeurosis, which was also transected during these dissections. The oral appliance used to retract the tongue and expose the larynx in our dissections may have caused this distortion of perspective. To confirm our contention, we reevaluated the cadaver from which the figure was captured and then performed 2 fresh cadaveric dissections on new specimens prepared in a similar manner as described in our article. To confirm the anatomic perspective, we performed an external dissection via a traditional neck dissection approach and identified the relevant anatomic structures (see Figure 1). The digastric muscle, hyoid bone, and lingual artery were tagged with sutures. We then proceeded to perform a transoral dissection with the same specimens to visualize these structures from the transoral perspective. Figure 2 shows these structures in their native position with the digastric appearing lateral to the lingual artery and the hyoid bone medial to both structures. Figure 3, however, with the retractor, demonstrates how the posterior belly of FIGURE 2. Transoral endoscopic view of lingual artery (left side). Arrowheads, the resection border of base of tongue. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]