Hyoglossus Muscle Contusion

A hyoglossus muscle contusion is a bruise of the hyoglossus, one of the four extrinsic muscles that control tongue movement. It results from a direct, blunt force to the floor of the mouth, leading to bleeding, swelling, and pain within the muscle fibers Cleveland Clinic. Like other muscle contusions, it is classified by severity—mild, moderate, or severe—based on pain intensity, range-of-motion loss, and hematoma size Medscape. Prompt recognition and appropriate management are key to restoring tongue function and preventing complications such as myositis ossificans (aberrant bone formation within the muscle).

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Anatomy of the Hyoglossus Muscle

Structure & Location

The hyoglossus is a thin, quadrilateral extrinsic muscle lying in the floor of the mouth, lateral to the genioglossus and immediately above the hyoid bone. It forms part of the submandibular triangle’s floor and blends with intrinsic tongue fibers KenhubWikipedia.

Origin

Fibers arise from the side of the hyoid bone—both the body and the greater cornu—overlapping slightly where these regions meet Wikipedia.

Insertion

Its vertically oriented fibers ascend to insert into the lateral aspect of the tongue, between the styloglossus (above) and the inferior longitudinal muscle (medially) Wikipedia.

Blood Supply

Primarily supplied by branches of the lingual artery (particularly its sublingual branch), with additional contributions from the submental branch of the facial artery Radiopaedia.

Nerve Supply

Motor innervation is via the hypoglossal nerve (cranial nerve XII), which controls tongue movements Wikipedia.

Functions

1. Depression of the tongue – Lowers the tongue’s central dorsum during speech and swallowing.

2. Retraction of the tongue – Draws the tongue back into the mouth for bolus clearance.

3. Flattening of the dorsum – Makes the tongue surface more convex for food manipulation.

4. Assisting elevation of the hyoid – During swallowing, helps stabilize the hyoid.

5. Aiding speech articulation – By adjusting tongue position for certain sounds.

6. Supporting airway patency – By controlling tongue bulk and position in the oropharynx KenhubWikipedia.

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Types of Contusion (Grades)

1. Grade I (Mild)

   • Minimal fiber damage, mild pain, full range of motion.

2. Grade II (Moderate)

   • Partial fiber tearing, moderate pain, reduced movement, possible hematoma.

3. Grade III (Severe)

   • Complete muscle rupture, severe pain, marked swelling, significant functional loss Medscape.

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Causes of Hyoglossus Contusion

1. Direct oral trauma (e.g., fall with chin impact)

2. Blunt force from sports equipment (e.g., mouthguard-less play)

3. Accidental tongue bite during seizures or bruxism

4. Dental instrument injury (e.g., during intubation or oral surgery)

5. Facial motor vehicle collision

6. Physical assault to the chin/jaw

7. High-velocity projectiles (e.g., ball impact)

8. Severe vomiting causing internal tongue compression

9. Alcohol-related falls leading to mouth trauma

10. Occupational hazards (e.g., accidental blow in combat sports)

11. Intraoral foreign body insertion

12. Maxillofacial surgery complications

13. Oral endoscopic procedures

14. Underlying coagulopathy exacerbating minor impacts

15. Anticoagulant therapy increasing bleed risk

16. Radiation-induced tissue fragility in head/neck cancer patients

17. Age-related tissue thinning in elderly

18. Infectious myositis weakening muscle integrity

19. Neuromuscular disorders (e.g., dystonia causing forceful contractions)

20. Iatrogenic injury from poorly placed laryngeal masks Cleveland Clinic.

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Symptoms

1. Local tongue pain at the floor of the mouth

2. Swelling of the lateral tongue border

3. Bruising (ecchymosis) on the tongue surface

4. Hematoma formation palpable as a firm lump

5. Difficulty retracting the tongue

6. Limited tongue depression

7. Altered speech articulation

8. Impaired swallowing (dysphagia)

9. Drooling due to poor tongue seal

10. Numbness or tingling if nerve compression occurs

11. Bleeding into the oral cavity

12. Tenderness on palpation

13. Submandibular pain radiating downward

14. Transient hoarseness if edema impinges airway structures

15. Oral ulceration from friction over hematoma

16. Pain exacerbated by tongue movement

17. Fever (rare; suggests secondary infection)

18. Trismus when severe edema restricts jaw opening

19. Myositis ossificans signs in chronic cases (hard nodules)

20. Persistent discomfort beyond two weeks OrthoInfo.

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Diagnostic Tests

1. Clinical oral examination – inspection and palpation

2. Ultrasound – assesses hematoma size and depth

3. Magnetic resonance imaging (MRI) – detailed soft‑tissue view

4. Computed tomography (CT) – rules out bony injury

5. X‑ray – to exclude mandibular fractures

6. Flexible endoscopy – airway evaluation if needed

7. Electromyography (EMG) – in suspected nerve injury

8. Complete blood count (CBC) – checks for infection

9. Coagulation profile – in bleeding disorders

10. Creatine kinase (CK) – muscle damage marker

11. Ultrasound‑guided aspiration – diagnostic/therapeutic for large hematomas

12. Biopsy – if malignancy or myositis ossificans suspected

13. Tongue mobility measurements – goniometry or ruler method

14. Pain scales – VAS or NRS

15. Swallow study (barium swallow) – in dysphagia

16. Speech assessment – by a speech‑language pathologist

17. Electrodiagnostic studies – for nerve conduction

18. Inflammatory markers – CRP, ESR

19. Ultrasound Doppler – vascular patency

20. Follow‑up imaging – monitors healing progression Medscape.

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Non‑Pharmacological Treatments

1. Rest – limit tongue use Cleveland Clinic

2. Ice packs – 20 minutes every 2 hours

3. Compression wraps – gentle bandaging under the chin rmts.clinic

4. Elevation – keep head upright during recovery

5. Protected diet – soft, cool foods (e.g., yogurt, smoothies)

6. Speech rest – minimize talking

7. Thermal therapy – warm compress after 48 hrs

8. Ultrasound therapy – promotes tissue repair PMC

9. Low‑level laser therapy – reduces inflammation

10. Electrical muscle stimulation – prevents atrophy

11. Manual lymphatic drainage – decreases tongue swelling

12. Gentle tongue stretches – improve flexibility

13. Isometric tongue exercises – strengthen fibers

14. Myofascial release – by an oral physiotherapist

15. Acupuncture – for pain control AAFP

16. Massage therapy – once acute phase resolves

17. Transcutaneous electrical nerve stimulation (TENS) – pain relief

18. Cold laser acupuncture – combined benefit

19. Hydrotherapy – cool water rinses

20. Honey mouthwash – anti‑inflammatory natural remedy

21. Aloe vera gel – soothes mucosal surfaces

22. Chiropractic neck adjustment – improves local circulation

23. Breathing exercises – reduces muscle tension

24. Biofeedback – for muscle relaxation

25. Ultrasonic phonophoresis – drug‑free anti‑inflammatory

26. Platelet‑rich plasma (PRP) injections – investigational

27. Cryotherapy with gas spray – direct cold application

28. Kinesiology taping – supports muscle alignment

29. Mind‑body relaxation – yoga, meditation

30. Nutritional support – vitamin C, zinc, protein‑rich diet PMC.

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Drugs

1. Ibuprofen (NSAID) – reduces pain and inflammation OrthoInfo

2. Naproxen (NSAID) – longer‑acting anti‑inflammatory

3. Diclofenac gel – topical pain relief

4. Aspirin – low‑dose analgesic

5. Acetaminophen – pain relief without anti‑inflammation Medscape

6. Ketorolac – potent short‑term NSAID

7. Celecoxib – COX‑2 selective NSAID

8. Mefenamic acid – NSAID alternative

9. Tizanidine – muscle relaxant

10. Cyclobenzaprine – muscle relaxant

11. Diazepam – benzodiazepine for muscle spasm

12. Chlorzoxazone – central muscle relaxant

13. Prednisone – short‑course oral corticosteroid

14. Dexamethasone – powerful corticosteroid

15. Lidocaine mouth rinse – local anesthetic

16. Benzocaine lozenges – topical analgesic

17. Chlorhexidine rinse – infection prevention

18. Tranexamic acid – for persistent bleeding

19. Opioid‑acetaminophen combinations – severe pain (short term)

20. Gabapentin – neuropathic pain component PubMedMedscape.

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Surgical Interventions

1. Hematoma evacuation – drain large collections

2. Fasciotomy – relieve compartment pressure

3. Debridement – remove necrotic tissue

4. Microvascular repair – restore blood flow in severe tears

5. Partial glossectomy – excise irreversibly damaged muscle

6. Nerve repair – if hypoglossal injury occurs

7. Suture repair of muscle fibers – realign torn fibers

8. Drain placement – continuous fluid removal

9. Reconstructive flap surgery – for tissue loss

10. Laser ablation – for myositis ossificans nodules.

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Preventive Measures

1. Use a mouthguard in contact sports

2. Ensure proper headgear in martial arts

3. Maintain good oral hygiene to avoid secondary infection

4. Warm up and stretch before exercise

5. Avoid anticoagulants before high‑risk activities

6. Manage coagulopathies under medical guidance

7. Supervised dental procedures with padded instruments

8. Fall‑prevention strategies in the elderly

9. Strengthen neck muscles to buffer impacts

10. Educate on safe tongue practices (e.g., avoid biting).

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When to See a Doctor

Seek prompt evaluation if you experience:

• Severe pain not eased by oral analgesics

• Rapidly expanding swelling obstructing the airway

• Persistent bleeding or oozing beyond 24 hours

• Signs of infection (fever, redness, pus)

• Difficulty breathing or swallowing

• Neurological symptoms (numbness, tingling) Cleveland Clinic.

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Frequently Asked Questions (FAQs)

1. What is a hyoglossus muscle contusion?
   A bruise of the hyoglossus—caused by a direct impact—leading to bleeding and swelling within the muscle fibers.

2. How long does it take to heal?
   Mild cases heal in 1–2 weeks; moderate in 3–4 weeks; severe up to 6 weeks or more, depending on management.

3. Can I eat normally afterward?
   Initially follow a soft, cool diet; gradually return to normal foods as pain allows.

4. Is it safe to speak?
   Limit speech in the first 48 hours; use gentle articulation exercises as pain subsides.

5. Will I have permanent damage?
   With proper care, full recovery is expected; untreated severe contusions may lead to scarring or reduced mobility.

6. Can contusion cause myositis ossificans?
   Yes—rarely, untreated hematomas can calcify, requiring later surgical removal.

7. Do I need imaging?
   Ultrasound or MRI can confirm hematoma size and rule out other injuries if clinical exam is inconclusive.

8. Are NSAIDs safe for tongue contusions?
   Short-term NSAIDs are effective for pain; long-term use may delay muscle healing.

9. Should I apply heat?
   Only after 48 hours; heat helps in the subacute phase to promote blood flow.

10. What exercises help recovery?
    Gentle tongue depressions, lateral stretches, and isometric holds under a therapist’s guidance.

11. Can speech therapy aid healing?
    Yes—especially for restoring articulation and swallowing mechanics.

12. Is massage recommended?
    Only after the acute phase (post–72 hours) and under professional supervision.

13. How do I prevent recurrence?
    Use protective gear and follow proper oral safety, especially during sports or high‑risk activities.

14. When is surgery necessary?
    Only for uncontrolled hematomas, compartment syndrome, or myositis ossificans.

15. Can anticoagulant medications cause worse contusions?
    Yes—discuss risks with your doctor before activities that may cause oral trauma.

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Last Updated: April 18, 2025.