Hyoglossus Muscle Contracture

Anatomy of the Hyoglossus Muscle
Types of Hyoglossus Muscle Contracture
Causes
Symptoms
Diagnostic Tests
Non‑Pharmacological Treatments
Pharmacological Treatments
Surgical Options
Prevention Strategies
When to See a Doctor
Frequently Asked Questions

Hyoglossus muscle contracture is a pathological condition characterized by permanent shortening and fibrosis of the hyoglossus, one of the extrinsic muscles of the tongue. This shortening leads to limited tongue depression and retraction, resulting in difficulties with speech articulation, swallowing, and maintaining proper airway patency. In contractures, normally elastic muscle fibers and surrounding connective tissues are replaced by inelastic fibrotic tissue, causing stiffness and reduced range of motion. Wikipedia NCBI

Anatomy of the Hyoglossus Muscle

Structure and Location

The hyoglossus is a thin, quadrilateral extrinsic tongue muscle situated in the floor of the mouth. It lies lateral to the geniohyoid and deep to the styloglossus, forming part of the tongue’s muscular wall. NCBI

Origin and Insertion

Origin: Along the body and greater cornu of the hyoid bone.
Insertion: Into the side of the posterior half of the tongue, between styloglossus laterally and the inferior longitudinal muscle medially. NCBI

Blood Supply and Lymphatics

The main arterial supply arises from the sublingual branch of the lingual artery. An accessory supply may come from the submental branch of the facial artery. Venous drainage is via the lingual vein, and lymphatic drainage flows to the deep cervical lymph nodes. NCBI

Nerve Supply

Motor innervation is provided exclusively by the hypoglossal nerve (cranial nerve XII), which courses deep to the sternocleidomastoid and external carotid before branching to the tongue muscles. NCBI

Functions

The hyoglossus muscle has six primary actions:

Tongue Depression: Lowers the posterior tongue.
Tongue Retraction: Draws the tongue base backward.
Bolus Propulsion: Aids in moving food toward the pharynx during swallowing.
Speech Articulation: Modulates sounds by adjusting tongue posture.
Airway Patency: Contributes to upper airway stability by positioning the tongue.
Maintaining Oral Posture: Helps keep the tongue flat against the floor of the mouth. PMC

Types of Hyoglossus Muscle Contracture

Congenital Contracture: Present at birth, often as part of syndromes like arthrogryposis multiplex congenita, where abnormal fibrosis limits muscle extension. Wikipedia
Acquired Contracture: Develops later due to trauma, surgical scarring, radiation fibrosis, or prolonged immobilization. Wikipedia
Neurologic Spastic Contracture: Results from upper motor neuron lesions (e.g., cerebral palsy, stroke) causing sustained hypertonicity and eventual fibrosis.
Ischemic Contracture: Follows compartment syndrome or vascular compromise leading to muscle necrosis and fibrotic shortening (e.g., Volkmann’s contracture mechanism applied to tongue muscles). Wikipedia

Causes

Surgical trauma to the tongue floor
Radiation therapy for head and neck cancer
Hypoglossal nerve palsy
Stroke affecting corticobulbar tracts
Cervical spine injury with tongue involvement
Infectious fibrosis (e.g., deep neck abscess)
Prolonged intubation trauma
Whiplash-associated myofascial tension PMC
Systemic sclerosis (scleroderma) involvement
Fibromatosis of the floor of mouth
Postoperative scarring from glossectomy
Myofascial pain syndromes
Radiation-induced fibrosis
Congenital muscular anomalies (e.g., arthrogryposis)
Idiopathic chronic spasm
Head and neck burns leading to skin/tissue contracture
Repetitive microtrauma (e.g., tongue biting)
Connective tissue disorders (e.g., Ehlers–Danlos paradoxical scarring)
Drug-induced myotoxicity (e.g., high-dose statins)
Degenerative neuromuscular diseases (e.g., amyotrophic lateral sclerosis)

Symptoms

Limited tongue depression
Reduced tongue retraction
Dysphagia (difficulty swallowing)
Dysarthria (speech difficulty)
Oral stage choking
Food residue in mouth
Altered taste sensation
Drooling (sialorrhea)
Glossalgia (tongue pain)
Tongue deviation on protrusion
Voice changes (nasality)
Snoring or sleep apnea
Weight loss from feeding difficulty
Recurrent aspiration pneumonia
Oral hygiene challenges
Jaw pain from compensatory muscle use
Bruxism (teeth grinding)
Oral ulcers from friction
Fatigue during speech
Social embarrassment and anxiety UPMC | Life Changing Medicine

Diagnostic Tests

Physical Exam: Assess range of tongue motion and palpation for fibrotic bands.
Tongue Range-of-Motion Measurement: Quantitative degrees of depression and retraction.
Ultrasound Imaging: Visualize muscle thickness and fibrosis.
Magnetic Resonance Imaging (MRI): Detailed anatomy and fibrotic changes.
Computed Tomography (CT) Scan: Assess bony and soft tissue involvement.
Electromyography (EMG): Measure muscle electrical activity. PMC
Nerve Conduction Studies: Evaluate hypoglossal nerve integrity.
Videofluoroscopic Swallow Study (VFSS): Dynamic assessment of swallowing function.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Real‑time visualization during swallowing.
Biomechanical Tongue-Pressure Testing: Quantify tongue strength.
Histopathology (Biopsy): Identify fibrosis and inflammatory cells.
Serum Creatine Kinase (CK): Detect muscle injury.
Genetic Testing: Rule out congenital myopathies.
Ultrasound Elastography: Measure tissue stiffness.
Surface Electrogustometry: Evaluate taste nerve function.
Speech-Language Pathology Assessment: Articulation and phonation analysis.
Oxygen Saturation Monitoring: Detect nocturnal desaturation due to airway compromise.
pH Monitoring: Assess reflux contributing to fibrosis.
Salivary Flow Measurement: Quantify drooling.
Quality-of-Life Questionnaires: Gauge functional impact.

Non‑Pharmacological Treatments

Gentle Stretching Exercises: Daily tongue depressor stretches.
Myofascial Release: Manual therapy to break fibrotic adhesions. Dove Press
Osteopathic Manipulative Treatment: Indirect mobilization of tongue and hyoid. Dove Press
Ultrasound Therapy: Promotes collagen remodeling.
Low‑Level Laser Therapy (LLLT): Reduces fibrosis and pain.
Heat Therapy: Increases tissue elasticity.
Cold Therapy: Controls inflammation in acute phase.
Transcutaneous Electrical Nerve Stimulation (TENS): Alleviates pain.
Neuromuscular Electrical Stimulation (NMES): Improves muscle contractile properties. PMC
Speech Therapy: Exercises to re‑educate tongue movement.
Swallowing Therapy: Bolus propulsion techniques.
Expiratory Muscle Strength Training (EMST): Enhances airway patency.
Biofeedback: Visual feedback for tongue positioning.
Tongue Splints: Gentle prolonged stretch.
Oral Appliances: Night guards to prevent bruxism.
Cranio‑Cervical Postural Training: Optimizes head and neck alignment.
Adaptive Yoga: Sustained stretches to reduce spasticity.
Acupuncture: May reduce spasm and pain.
Dry Needling: Targeted trigger point release.
Vibration Therapy: Promotes tissue flexibility.
Shockwave Therapy: Breaks down fibrosis.
Manual Lymphatic Drainage: Reduces local edema.
Hydration and Soft Diet Modifications: Prevents mechanical irritation.
Cognitive Behavioral Techniques: Manage pain‑related anxiety.
Oral Motor Training Devices: Resistance‑based strengthening.
Hypoglossal Nerve Stimulation (HNS): Neuromodulation to improve tone. Carver College of Medicine
Positional Therapy: Prevent tongue retraction at night.
Occupational Therapy: Daily living adaptations.
Nutritional Support: Ensure adequate protein for tissue repair.
Patient Education: Self‑management strategies.

Pharmacological Treatments

Baclofen (Lioresal) – centrally acting spasticity reducer.
Tizanidine (Zanaflex) – α₂‑agonist muscle relaxant.
Cyclobenzaprine (Flexeril) – short‑term relief of muscle spasm.
Methocarbamol (Robaxin) – centrally acting agent.
Carisoprodol (Soma) – centrally acting relaxant.
Dantrolene (Dantrium) – peripherally acting, reduces calcium release.
Chlorzoxazone (Parafon) – central muscle relaxant.
Orphenadrine (Norflex) – anticholinergic muscle relaxant.
Diazepam (Valium) – benzodiazepine with muscle‑relaxing effects.
Botulinum Toxin Type A – local chemodenervation for focal fibrosis.
Gabapentin – neuropathic pain control, may reduce spasm.
Pregabalin – adjunct for nerve-related discomfort.
NSAIDs (Ibuprofen, Naproxen) – reduce inflammation and pain.
Acetaminophen – analgesic adjunct.
Intrathecal Baclofen – for severe spasticity not controlled orally.
Clonidine – adjunct spasticity management.
Cyclobenzaprine/Acetaminophen combination – multimodal relief.
Gabapentin/Baclofen combination – synergistic muscle relaxation.
Calcitonin – off‑label for some myofascial pain.
Cannabinoid Extracts – emerging evidence for spasticity reduction. Drugs.com

Surgical Options

Tenotomy (Tendon Lengthening): Small incisions to lengthen the hyoglossus tendon. Cleveland Clinic
Myotomy of Hyoglossus: Direct muscle fiber release to restore length.
Z‑Plasty: Zig‑zag incision technique to break fibrotic bands. Cleveland Clinic
Fasciotomy: Release of dense fascia associated with contracture.
Free‑Flap Reconstruction: For extensive tongue defects post‑release. NCBI
Glossectomy (Partial): Removal of fibrotic tissue when refractory. NCBI
Hypoglossal Nerve Decompression: Relieve nerve entrapment contributing to spasm.
Transoral Laser Microsurgery (TLM): Precise release of fibrotic bands. Optecoto
Transoral Robotic Surgery (TORS): Minimally invasive fibrosis excision. Optecoto
Botulinum Toxin Surgical Injection: Combined surgical and chemodenervation approach.

Prevention Strategies

Early Mobilization: Begin tongue exercises post‑surgery or trauma. UPMC | Life Changing Medicine
Regular Stretching: Daily structured tongue stretches.
Protective Oral Appliances: Night guards to prevent bruxism.
Optimize Hydration and Nutrition: Support tissue elasticity.
Radiation‑Sparing Techniques: Minimize oral fibrosis in cancer therapy.
Physical Therapy Referrals: Maintain muscle flexibility.
Postural Education: Keep head/neck alignment to reduce tension.
Prompt Treatment of Infections: Prevent deep neck abscess‑related fibrosis.
Neurosurgical Care: Early management of hypoglossal nerve injury.
Patient Education: Recognize early signs of stiffness and seek care.

When to See a Doctor

Persistent difficulty swallowing or choking episodes UPMC | Life Changing Medicine
Speech changes lasting more than two weeks
Uncontrolled tongue pain or spasms
Significant weight loss from feeding issues
Signs of aspiration pneumonia (coughing during meals)
New drooling or inability to clear saliva
Sleep-disordered breathing or snoring
Visible tongue deviation or atrophy
Difficulty maintaining oral hygiene
Any rapid onset of tongue stiffness or fibrosis

Frequently Asked Questions

What causes hyoglossus muscle contracture?
Contracture arises from muscle fibrosis following trauma, surgery, radiation, or neurologic injury. Wikipedia
How is it diagnosed?
Diagnosis involves physical exam, imaging (MRI/ultrasound), EMG, and swallowing studies.
Can contracture be reversed?
Early-stage contractures may respond to intensive therapy; long-standing fibrosis often requires surgical release.
What non‑surgical options exist?
Stretching, myofascial release, NMES, ultrasound, and speech/swallow therapy.
When is surgery necessary?
If functional impairment persists despite conservative measures or when fibrosis is severe.
Is physical therapy effective?
Yes—targeted exercises and manual techniques can improve range and reduce fibrosis progression.
What drugs help with fibrosis?
Muscle relaxants (baclofen, tizanidine), NSAIDs for pain, and botulinum toxin for focal spasm.
How long is recovery after surgery?
Varies by procedure; minor myotomies may heal in 2–4 weeks, while flaps/glossectomies take longer.
Can it recur?
Yes—ongoing stretching and therapy are crucial to prevent re‑fibrosis.
Does it affect airway?
Hyoglossus contracture can narrow the airway, contributing to sleep apnea.
Is there a genetic component?
Congenital forms (e.g., arthrogryposis) have genetic links; most cases are acquired.
Are there experimental treatments?
Research into anti‑fibrotic agents and regenerative therapies is ongoing.
What lifestyle changes help?
Good hydration, balanced diet, posture awareness, and regular oral exercises.
Can speech return to normal?
Often improves significantly with combined therapy, though may not fully normalize in severe cases.
How do I find a specialist?
Consult an otolaryngologist (ENT), oral maxillofacial surgeon, or speech‑language pathologist experienced in tongue disorders.

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

Last Updated: April 18, 2025.

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