Response to Letter to Editor

We sincerely thank the reader for their careful evaluation of our work and for raising this important methodological point. We would like to clarify that, while our systematic review included a range of study types—such as case reports, operational studies, reviews, and commentary articles to provide a comprehensive overview of the topic—only studies with extractable quantitative data (i.e., clearly reported patient numbers and outcomes) were included in the quantitative synthesis (meta-analysis). Specifically, studies such as Birchall et al. (T1, commentary) and Chi et al. (T4, review) were included in the qualitative component of the systematic review to provide contextual and background insights into the evolution of tongue transplantation.1-3 However, as correctly noted, these studies do not report numerical patient data and therefore did not contribute to the pooled effect estimates. This is reflected in the forest plot, where these entries are marked as “not estimable,” indicating that they were not included in the statistical weighting or calculation of the pooled outcomes. Only studies with available numerical data contributed to the meta-analytic model. We acknowledge that this distinction between qualitative inclusion and quantitative contribution could have been more explicitly stated in the manuscript. We appreciate this observation and agree that clarifying this point would improve transparency and interpretability. We will revise the Methods and Results sections accordingly to clearly delineate which studies were included in the meta-analysis versus those included for descriptive purposes only. Thank you again for this valuable feedback, which has helped strengthen the clarity of our work. Ali Talib Hashim: conceptualization, methodology, data curation, validation, supervision, writing–original draft. The author received no specific funding for this work. The author declares no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.