Hyoglossus Muscle Atrophy

Hyoglossus muscle atrophy refers to the progressive wasting and loss of mass of the hyoglossus, one of the four extrinsic muscles of the tongue. In healthy muscle, the balance between protein synthesis and degradation maintains muscle size and strength; atrophy occurs when degradation outpaces synthesis, leading to reduced fiber diameter and strength PMC. In the case of the hyoglossus, this manifests as diminished ability to depress and retract the tongue, impacting swallowing, speech, and oral function Wikipedia.

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Anatomy of the Hyoglossus Muscle

Structure & Location

The hyoglossus is a thin, quadrilateral extrinsic muscle found in the floor of the mouth. It lies lateral to the geniohyoid and medial to the mylohyoid, forming part of the submandibular triangle’s floor WikipediaKenhub.

Origin

Fibers arise from the entire length of the greater cornu (horn) and the adjacent body of the hyoid bone. Those from the body overlap those from the horn, creating a broad, flat origin Wikipedia.

Insertion

The fibers pass almost vertically upward to insert into the side of the tongue, interdigitating between the styloglossus laterally and the inferior longitudinal intrinsic muscle medially Wikipedia.

Vascular Supply

Arterial blood reaches the hyoglossus primarily via the sublingual branch of the lingual artery, with supplemental supply from the submental branch of the facial artery RadiopaediaWikipedia.

Innervation

Motor innervation is provided by the hypoglossal nerve (CN XII), which courses deep to the muscle before supplying its fibers WikipediaKenhub.

Functions

1. Depression of the tongue: Lowers the tongue to the floor of the mouth.

2. Retraction of the tongue: Pulls the tongue backward into the oral cavity.

3. Flattening of the dorsum: Makes the tongue’s top surface more convex.

4. Widening of the tongue body: Pulls the lateral borders downward.

5. Facilitation of swallowing: Moves bolus posteriorly toward the pharynx.

6. Speech articulation: Positions the tongue for consonant and vowel production KenhubWikipedia.

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Types of Muscle Atrophy

Muscle atrophy is broadly classified into three main categories PubMed:

• Physiologic atrophy: Due to disuse or immobilization (e.g., bed rest).

• Pathologic atrophy: Linked to systemic factors like aging (sarcopenia) or malnutrition.

• Neurogenic atrophy: Results from loss of nerve supply (e.g., hypoglossal nerve palsy).

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Causes of Hyoglossus Muscle Atrophy

1. Hypoglossal nerve injury (trauma, surgery)

2. Amyotrophic lateral sclerosis (ALS)

3. Brainstem stroke (medial medullary syndrome)

4. Spinal muscular atrophy

5. Multiple sclerosis

6. Guillain–Barré syndrome

7. Head and neck tumors (compressing nerve)

8. Radiation therapy to the neck

9. Prolonged intubation or airway devices

10. Disuse (e.g., prolonged mouth guard use)

11. Malnutrition (protein deficiency)

12. Cachexia (cancer-related)

13. Sarcopenia (age-related)

14. Chronic obstructive pulmonary disease (systemic inflammation)

15. Chronic heart failure

16. Chronic kidney disease

17. Sepsis (critical illness myopathy)

18. Autoimmune myositis

19. Endocrine disorders (e.g., Cushing’s syndrome)

20. Medications (glucocorticoids)
    These causes are drawn from comprehensive reviews of muscle atrophy mechanisms PMCPMC.

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Symptoms of Hyoglossus Muscle Atrophy

1. Tongue weakness on protrusion

2. Difficulty depressing the tongue

3. Speech slurring (dysarthria)

4. Swallowing difficulties (dysphagia)

5. Tongue deviation toward the atrophic side

6. Tongue fasciculations (twitching)

7. Atrophy visible on inspection (thin tongue)

8. Difficulty chewing

9. Drooling (sialorrhea)

10. Choking or aspiration episodes

11. Food pocketing in mouth

12. Reduced speech clarity

13. Fatigue with prolonged speaking

14. Sense of a “heavy” tongue

15. Altered taste sensation (secondary to motility issues)

16. Dry mouth (reduced saliva spread)

17. Voice changes (nasal speech)

18. Throat discomfort

19. Unexplained weight loss (due to eating difficulty)

20. Anxiety or depression (quality-of-life impact)
    Based on clinical presentations of hypoglossal nerve disorders Cleveland ClinicMerck Manuals.

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Diagnostic Tests

1. Clinical oral examination

2. Cranial nerve XII function test (tongue protrusion)

3. Electromyography (EMG) of the tongue

4. Nerve conduction studies

5. Magnetic resonance imaging (MRI) of brainstem and neck

6. Computed tomography (CT) of skull base

7. Ultrasound of the tongue muscles

8. Videofluoroscopic swallow study

9. Fiberoptic endoscopic evaluation of swallowing (FEES)

10. Tongue strength measurement (IOPI device)

11. Serum creatine kinase (CK) level

12. Nutritional panel (albumin, prealbumin)

13. Thyroid function tests

14. Autoimmune serologies (e.g., ANA, anti–Jo-1)

15. Genetic testing for inherited atrophy (SMA genes)

16. Muscle biopsy (rarely)

17. Airway assessment (for aspiration risk)

18. Voice and speech evaluation

19. Psychological assessment (impact on quality of life)

20. Electroencephalogram (EEG) if central lesions suspected
    Compiled from neurophysiological and imaging guidelines TeachMeAnatomyWikipedia.

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Non-Pharmacological Treatments

1. Speech therapy (articulation exercises)

2. Swallowing therapy (thermal-tactile stimulation)

3. Tongue resistance exercises (against depressor)

4. Orofacial myofunctional therapy

5. Neuromuscular electrical stimulation (NMES)

6. Biofeedback training for tongue control

7. Tongue stretching

8. Thermal stimulation

9. Soft diet modification

10. Thickened liquids to prevent aspiration

11. Postural adjustments during eating

12. Acupuncture

13. Massage of floor of mouth

14. Warm compresses

15. Cryotherapy (cold packs)

16. Dry needling

17. Low-level laser therapy

18. Ultrasound therapy

19. Magnetic stimulation

20. Physical therapy (neck posture)

21. Occupational therapy (adaptive eating aids)

22. Respiratory therapy (to protect airway)

23. Nutritional counseling

24. Hydration optimization

25. Protein-rich diet

26. Creatine supplementation

27. β-Hydroxy β-methylbutyrate (HMB) supplementation

28. Vitamin D optimization

29. Resistance training (neck and jaw)

30. Stress management (relaxation techniques)
    Based on multidisciplinary rehabilitation strategies PMCPMC.

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Pharmacological Treatments

1. Testosterone (anabolic support)

2. Oxandrolone (anabolic steroid)

3. Growth hormone (GH)

4. Insulin-like growth factor‑1 (IGF‑1)

5. Metformin (anti-catabolic effects)

6. Lithium chloride (anti-inflammatory)

7. Resveratrol (antioxidant)

8. N‑acetylcysteine (antioxidant)

9. Pyrroloquinoline quinone (signal modulator)

10. Celecoxib (anti-inflammatory)

11. Aspirin (anti-inflammatory)

12. Pentoxifylline (microcirculation enhancer)

13. Roflumilast (phosphodiesterase inhibitor)

14. Imidazolo‑oxindole (kinase inhibitor)

15. Carnosol (antioxidant)

16. Isoquercetin (flavonoid antioxidant)

17. Magnesium lithospermate B (TCM extract)

18. Puerarin (TCM extract)

19. Ginsenosides (TCM extract)

20. Tetramethylpyrazine (TCM extract)
    Drawn from recent therapeutic reviews PMC.

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Surgical Interventions

1. Microvascular decompression (MVD) for vascular compression of CN XII Lippincott JournalsSurgical Neurology International.

2. Tumor excision in hypoglossal canal to relieve compression Wikipedia.

3. Classic hypoglossal–facial nerve anastomosis (end‑to‑end) PubMedPubMed.

4. Partial hypoglossal–facial neurorrhaphy (preserves some tongue function) Houston Methodist Leading MedicineThe Journal of Neuroscience.

5. Descendens hypoglossi (ansa cervicalis) neurotization to restore tongue innervation PubMed.

6. Facial reanimation with ansa cervicalis transfer to minimize tongue morbidity PMC.

7. Sural nerve interposition graft between CN XII and facial nerve PMC.

8. Nerve transfer with partial CN XII division (partial transfer technique) Houston Methodist Leading MedicineFacial Palsy UK.

9. Hypoglossal nerve stimulator implant for obstructive sleep apnea (tongue base pacing) Wikipedia.

10. “Babysitter” procedure (cross‑face graft plus hypoglossal babysitting) to maintain muscle viability Wikipedia.

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Preventive Measures

1. Careful surgical technique to avoid CN XII injury Practical Neurology.

2. Limit prolonged intubation and airway device pressure Practical Neurology.

3. Early mobilization of tongue (oral exercises)

4. Adequate protein intake

5. Routine swallowing and speech exercises

6. Manage systemic diseases (diabetes, heart failure)

7. Maintain good oral hygiene

8. Avoid prolonged mouth‑guard use without breaks

9. Nutritional optimization (vitamins D, E)

10. Regular neuromuscular assessments in at‑risk patients PMC.

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When to See a Doctor

• Persistent difficulty swallowing or speaking

• Tongue deviation or visible thinning

• Frequent choking or aspiration

• New tongue fasciculations or weakness

• Pain or tingling in the tongue

• Unexplained weight loss or malnutrition

• Post‑operative tongue weakness

• Speech deterioration affecting daily life

• Respiratory complications from aspiration

• Rapid progression of tongue dysfunction
  Early evaluation can identify treatable causes and prevent complications Cleveland ClinicMerck Manuals.

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Frequently Asked Questions (FAQs)

1. What exactly is hyoglossus muscle atrophy?
   It’s the loss of muscle fibers in the hyoglossus, leading to a thinner, weaker tongue that can’t depress or retract properly PMC.

2. What causes hypoglossal nerve injury leading to atrophy?
   Commonly trauma, head and neck surgery, radiation, and neurological diseases like ALS Cleveland Clinic.

3. Can atrophy be reversed?
   Early-stage atrophy from disuse or mild denervation may improve with therapy and stimulation; advanced neurogenic atrophy often requires surgical or advanced interventions PMC.

4. How is hyoglossus atrophy diagnosed?
   Through clinical exam, EMG, imaging (MRI), and swallow studies TeachMeAnatomy.

5. Are there exercises to strengthen the hyoglossus?
   Yes—tongue‑depression resistance training and neuromuscular electrical stimulation can be effective PMC.

6. What medications help muscle atrophy?
   Anabolic agents (testosterone, GH), antioxidants (resveratrol), and anti‑inflammatories (celecoxib) may slow progression PMC.

7. When is surgery necessary?
   If there’s nerve compression, tumor, or severe denervation unresponsive to rehab, surgical decompression or nerve repair is considered Lippincott Journals.

8. What is the success rate of hypoglossal–facial nerve anastomosis?
   Many patients regain facial motion but may have some tongue weakness; partial techniques reduce tongue morbidity Houston Methodist Leading Medicine.

9. Can nutrition impact recovery?
   Yes—a protein‑rich diet with supplements (HMB, vitamin D) supports muscle synthesis PMC.

10. Is hyoglossus atrophy painful?
    It’s typically not painful but may cause discomfort or a “heavy” tongue sensation Cleveland Clinic.

11. How long does recovery take?
    Rehab may take weeks to months; nerve regeneration surgeries require several months for reinnervation PubMed.

12. Can electrical stimulation alone reverse atrophy?
    It can help in mild cases but is best combined with exercises and nutrition PMC.

13. Are there experimental treatments?
    Gene therapy, stem cell, and myostatin inhibitors are under investigation PMC.

14. Does aging always lead to hyoglossus atrophy?
    Aging (sarcopenia) can affect all skeletal muscles, including the tongue, but exercise can mitigate it PMC.

15. Where can I find support?
    Seek speech‑language pathologists, neurologists, and rehabilitation specialists for comprehensive care.

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Last Updated: April 18, 2025.