Superior Longitudinal Muscle Fibrosis

Fibrosis of the superior longitudinal muscle of the tongue is a condition in which healthy muscle fibers are replaced by excess connective tissue (scar), making the muscle stiff and less able to move. In fibrosis, specialized cells called fibroblasts and myofibroblasts lay down extra collagen, leading to thickening and hardening of the muscle WikipediaPubMed. As scar tissue grows, the tongue’s ability to shorten, curl, and shape itself is impaired, often causing difficulty with speech, chewing, and swallowing PMC.

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Anatomy of the Superior Longitudinal Muscle

Structure & Location

• A thin layer of oblique and longitudinal fibers lying just under the mucous membrane on the top (dorsal) surface of the tongue RadiopaediaIMAIOS.

• Confined entirely within the tongue (an intrinsic muscle), with no bony attachments RadiopaediaNCBI.

Origin

Fibers arise from the median fibrous (lingual) septum and the submucosal fibrous layer near the epiglottis RadiopaediaIMAIOS.

Insertion

Fibers run forward and insert into the tongue margins and overlying mucous membrane, extending to the tip and lateral edges RadiopaediaIMAIOS.

Blood Supply

Primarily from the lingual artery (a branch of the external carotid), which gives off:

1. Dorsal lingual arteries – supply the back (root) and dorsum of the tongue.

2. Deep lingual arteries – supply the body (anterior two‑thirds) of the tongue KenhubTeachMeAnatomy.

Nerve Supply

Motor innervation by the hypoglossal nerve (cranial nerve XII), which controls all intrinsic tongue muscles RadiopaediaWikipedia.

Main Functions

1. Shortening and widening the tongue when it contracts alone.

2. Dorsiflexion (curling the tip and sides upward) of the tongue apex.

3. Retracting and slightly shortening the tongue when working with the inferior longitudinal muscle.

4. Shaping the tongue to assist in precise speech articulation.

5. Forming the dorsal surface contour for taste sensation and bolus control during chewing.

6. Assisting in complex movements during swallowing and food manipulation RadiopaediaNCBI.

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Types of Superior Longitudinal Muscle Fibrosis

1. Focal (Localized) Fibrosis: Scar tissue in one small area of the muscle.

2. Diffuse Fibrosis: Uniform scarring throughout much of the muscle.

3. Replacement Fibrosis: Complete loss of muscle fibers replaced by collagen.

4. Interstitial Fibrosis: Excess collagen deposited between otherwise normal fibers.

5. Post‑traumatic Fibrosis: Follows tongue injury or surgery.

6. Radiation‑induced Fibrosis: After radiation therapy to head and neck.

7. Autoimmune‑mediated Fibrosis: e.g., systemic sclerosis affecting tongue tissues.

8. Idiopathic Fibrosis: No identifiable cause.

9. Congenital Fibrosis: Present at birth, often genetic.

10. Secondary Fibrosis: Due to adjacent tissue disease (e.g., oral submucous fibrosis) BioMed CentralPMC.

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Causes

1. Oral Submucous Fibrosis (betel nut chewing)

2. Head & neck radiation

3. Traumatic injury (bites, falls)

4. Surgical scars (e.g., tongue reduction)

5. Systemic sclerosis (scleroderma)

6. Amyloidosis

7. Infectious myositis (viral/bacterial)

8. Myofascial pain syndrome

9. Muscular dystrophies (e.g., Duchenne)

10. Idiopathic inflammatory myopathies (polymyositis)

11. Graft‑versus‑host disease

12. Chronic ulcerative lesions

13. Autoimmune diseases (e.g., lupus)

14. Diabetes‑related microangiopathy

15. Neurologic denervation

16. Chemical injuries (caustic agents)

17. Radiation‑related fibrosis

18. Aging‑related sarcopenia

19. Genetic collagen disorders

20. Persistent mechanical irritation (sharp teeth) WikipediaPubMed.

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Symptoms

1. Stiff tongue unable to move freely

2. Reduced tongue shortening on protrusion

3. Difficulty curling tongue tip upward

4. Slurred speech (dysarthria)

5. Trouble swallowing (dysphagia)

6. Altered taste sensation

7. Pain or discomfort in tongue

8. Burning feeling under the mucosa

9. Visible scar bands under mucous membrane

10. Dry mouth due to limited saliva spread

11. Chewing difficulty bolus manipulation

12. Food trapping at sides of tongue

13. Impaired gag reflex

14. Difficulty with oral hygiene

15. Tongue atrophy over time

16. Fatigue when speaking or eating

17. Salivary pooling in mouth floor

18. Voice changes (nasal tone)

19. Mouth opening reduction (trismus)

20. Sleep breathing issues (if severe) PMCPhysiopedia.

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Diagnostic Tests

1. Clinical exam of tongue mobility

2. Palpation for fibrotic bands

3. Ultrasound to detect tissue stiffness

4. MRI for soft‑tissue characterization RadiopaediaNCBI

5. Elastography (ultrasound‑based stiffness mapping)

6. Electromyography (EMG) for muscle activity

7. Nerve conduction studies (if neuropathy suspected)

8. Oral biopsy with histopathology PMC

9. Masson’s trichrome stain for collagen on biopsy PMC

10. Blood tests for autoimmune markers (ANA, Scl‑70)

11. Muscle enzymes (CK, LDH)

12. Serum inflammatory markers (ESR, CRP)

13. Genetic testing (if congenital myofibrosis)

14. Sialometry for saliva flow

15. Swallow study (barium videofluoroscopy)

16. Speech analysis (acoustic measures)

17. Surface electromyography

18. 3D motion capture of tongue movement

19. CT scan (to evaluate skeletal changes)

20. Psychological assessment (impact on quality of life).

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Non‑Pharmacological Treatments

1. Tongue stretching exercises

2. Myofascial release massage

3. Heat therapy to soften scar tissue

4. Cold therapy to reduce discomfort

5. Ultrasound therapy to promote tissue remodeling

6. Low‑level laser therapy

7. Electrical stimulation (NMES)

8. Biofeedback‑guided tongue drills

9. Manual scar mobilization

10. Transcutaneous electrical nerve stimulation (TENS)

11. Acupuncture

12. Speech therapy for articulation

13. Swallow rehabilitation exercises

14. Ergonomic oral appliances

15. Orthodontic interventions (to remove irritation)

16. Dietary modifications (softer foods)

17. Hydration & saliva substitutes

18. Therapeutic ultrasound‑guided needle release

19. Extracorporeal shock wave therapy

20. Psychological support (stress reduction)

21. Yoga and relaxation techniques

22. CMF vibration therapy

23. Compressed air massage

24. Manual lymphatic drainage

25. Proprioceptive neuromuscular facilitation

26. Cryo‑injections (liquid nitrogen spray)

27. Cold plasma treatment

28. Dental splints

29. Night‑time oral guards

30. Home‑based self‑mobilization protocols PhysiopediaPMC.

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Drugs

1. Corticosteroids (intralesional) – reduce inflammation

2. Pentoxifylline – improves microcirculation WikipediaBioMed Central

3. Colchicine – antifibrotic effects PMC

4. Interferon‑γ – alters collagen synthesis Wikipedia

5. Hyaluronidase (injection) – breaks down hyaluronic acid

6. Lycopene – antioxidant for oral fibrosis BioMed Central

7. Curcumin – anti‑inflammatory, antifibrotic ScienceDirect

8. Vitamin A & E supplements

9. Pentoxifylline + vitamin E combination

10. Tranilast – mast cell stabilizer

11. ACE inhibitors (e.g., enalapril) – modulate TGF‑β

12. Losartan – angiotensin receptor blocker (antifibrotic)

13. Pirfenidone – approved for lung fibrosis (off‑label)

14. Nintedanib – tyrosine kinase inhibitor (off‑label)

15. Metformin – reduces TGF‑β signaling

16. Imatinib – PDGFR inhibition

17. Halofuginone – collagen synthesis inhibitor

18. Mycophenolate mofetil – immunosuppressant

19. Methotrexate – low‑dose immunomodulation

20. Colestyramine – binds profibrotic bile acids ScienceDirectPhysiological Reports.

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Surgeries

1. Scar excision of fibrotic bands

2. Z‑plasty to lengthen scarred tissue Wikipedia

3. Mucosal grafting (tongue or buccal mucosa)

4. Laser scar release (CO₂ laser)

5. Cryosurgical release of bands

6. Micro‑surgical fascial release

7. Genioglossus advancement (for airway)

8. Free flap reconstruction (severe defects)

9. Allograft acellular matrix placement

10. Tongue reduction surgery (if hypertrophic) WikipediaPMC.

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Prevention Measures

1. Avoid betel nut/tobacco chewing

2. Protect tongue from trauma (bite guards)

3. Maintain good oral hygiene

4. Regular tongue stretching (after surgery)

5. Hydration to keep mucosa healthy

6. Manage systemic diseases (e.g., scleroderma)

7. Moderate alcohol intake

8. Nutritional support (vitamins A, C, E)

9. Early speech/physiotherapy referral

10. Sun protection (UV exposure can worsen scarring) WikipediaWikipedia.

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When to See a Doctor

• Persistent stiffness limiting speech or swallowing

• Pain that does not improve with home care

• Visible fibrotic bands under tongue mucosa

• Weight loss due to chewing/swallowing difficulty

• Speech changes impacting daily life

• New onset sensory loss or numbness

• Signs of infection (redness, fever)

• Rapid progression of scar formation

• Breathing difficulties at night

• Suspected malignancy in scarred areas PMCWikipedia.

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Frequently Asked Questions

1. What causes tongue fibrosis?
   Excess collagen deposition after injury, surgery, radiation, or systemic disease BioMed CentralWikipedia.

2. Can fibrosis of the tongue be reversed?
   Early fibrosis may improve with therapy; long‑standing scar is often permanent but can be softened by laser or injections WikipediaPMC.

3. Is tongue fibrosis painful?
   It can cause burning or aching pain, especially when moving the tongue PMCPhysiopedia.

4. How is fibrosis diagnosed?
   By clinical exam, imaging (ultrasound, MRI), and biopsy with histology RadiopaediaPMC.

5. Can I exercise my tongue safely?
   Yes—gentle stretching under guidance can help maintain flexibility PhysiopediaPMC.

6. Are injections helpful?
   Hyaluronidase, corticosteroids, and interferon‑γ injections can reduce scarring WikipediaBioMed Central.

7. What oral habits worsen fibrosis?
   Chewing betel nut, smoking, or alcohol can exacerbate scar formation WikipediaPhysiopedia.

8. Is surgery always needed?
   No—many cases respond to non‑surgical therapies; surgery is for severe, function‑limiting scarring WikipediaPMC.

9. Can fibrosis affect taste?
   Yes—scar tissue can alter taste bud function, leading to changes in taste perception PMCWikipedia.

10. Will fibrosis come back after treatment?
    Recurrence is possible if underlying causes (e.g., autoimmune disease) are not addressed WikipediaBioMed Central.

11. Are there natural remedies?
    Antioxidants like curcumin and lycopene may help, but evidence is limited BioMed CentralScienceDirect.

12. Can children get this?
    Rarely—when congenital or after pediatric tongue surgery or burns PMCBioMed Central.

13. How long does recovery take?
    Varies—weeks to months with therapy; surgical recovery may take 4–6 weeks WikipediaPMC.

14. Is tongue fibrosis dangerous?
    It is benign but can severely impact nutrition, speech, and quality of life PMCPubMed.

15. Where can I get help?
    Consult an ENT specialist, speech therapist, or oral surgeon for a tailored treatment plan.

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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 22, 2025.

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