Hyoglossus Muscle Sprain

A hyoglossus muscle sprain—more accurately described as a strain—is an injury to the extrinsic tongue muscle known as the hyoglossus. This muscle originates on the hyoid bone and inserts into the side of the tongue, acting primarily to depress and retract it. A “sprain” typically refers to ligament damage, whereas a muscle injury is called a “strain.” However, in everyday language, “sprain” is sometimes used interchangeably with “strain” when referring to soft‑tissue injuries of muscles. In a hyoglossus strain, muscle fibers are overstretched or torn due to excessive force, sudden movements, or blunt trauma, leading to pain, weakness, and impaired tongue mobility WikipediaVerywell Health.

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Anatomy of the Hyoglossus Muscle

Structure and Location

The hyoglossus is a thin, quadrilateral extrinsic tongue muscle situated in the floor of the oral cavity. It forms part of the submandibular triangle and lies lateral to the genioglossus and medial to the mylohyoid muscle. Its fibers run almost vertically from the hyoid bone into the tongue body Wikipedia.

Origin

Fibers of the hyoglossus arise from two main parts of the hyoid bone:

• The side of the hyoid body

• The entire length of the greater cornu (horn) of the hyoid
  Fibers from these two regions overlap, giving the muscle a broad base on the hyoid Wikipedia.

Insertion

The muscle fibers pass vertically upward and insert into the side of the tongue, blending between the styloglossus laterally and the inferior longitudinal muscle medially. This strategic insertion allows it to influence tongue shape and position Wikipedia.

Blood Supply

Primary arterial supply to the hyoglossus comes from branches of the lingual artery, notably the deep lingual and sublingual branches. Contribution may also come from the tonsillar artery and the submental branch of the facial artery, forming an anastomotic network that ensures robust perfusion to this region RadiopaediaTeachMeAnatomy.

Nerve Supply

Motor innervation is provided by the hypoglossal nerve (cranial nerve XII). This nerve courses superficial to the hyoglossus, supplying it with signals necessary for coordinated tongue movements in speech, swallowing, and mastication Wikipedia.

Functions

Although the hyoglossus has two primary mechanical actions, it contributes to multiple oral functions. Its six key roles include:

1. Depression of the tongue: Lowers the tongue from its resting position.

2. Retraction of the tongue: Pulls the tongue backward into the mouth.

3. Flattening the dorsum: Makes the upper surface of the tongue more convex.

4. Assisting in swallowing: Helps propel the food bolus posteriorly.

5. Facilitating speech: Participates in shaping sounds that require tongue depression.

6. Supporting mastication: Works with other muscles to optimize tongue position during chewing WikipediaWikipedia – Die freie Enzyklopädie.

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Types of Hyoglossus Muscle Sprain

Soft‑tissue muscle injuries are classified by severity and chronicity. A hyoglossus strain can be:

• Acute: Resulting from a single traumatic event (e.g., a sudden blow or overstretching).

• Chronic: From repetitive microtrauma or overuse (e.g., repetitive speech therapy exercises).

Clinically, muscle strains are graded I–III based on fiber disruption:

• Grade I (Mild): Few fibers overstretched or torn; minimal loss of strength or motion Cleveland ClinicPhysiopedia.

• Grade II (Moderate): Partial tearing of fibers; notable pain, swelling, and some loss of function Cleveland ClinicPMC.

• Grade III (Severe): Complete tear of the muscle; major loss of function and often requires surgical repair Cleveland ClinicRadiopaedia.

Causes of Hyoglossus Muscle Sprain

Common factors leading to hyoglossus strains mirror those of general muscle injuries:

1. Direct blunt trauma to the floor of the mouth

2. Excessive stretching during oral surgery (e.g., intubation)

3. Forceful tongue retraction maneuvers

4. Overextension in speech therapy exercises

5. Accidental biting of the tongue

6. Insertion or manipulation of oral devices (endoscopes)

7. Vigorous suction during dental procedures

8. Impact from foreign bodies

9. Iatrogenic injury in hyoid or tongue surgery

10. Rapid yawning with wide mouth opening

11. Repetitive speech with extreme tongue positions

12. Alcohol‑induced lack of protective reflexes leading to trauma

13. Seizure‑related tongue injuries

14. Contact sports injuries (e.g., mouth guard dislodgment)

15. Oral piercings

16. Bruxism (teeth grinding) causing tongue trauma

17. Radiotherapy to the head and neck region weakening tissues

18. Botulinum toxin spread to hyoglossus area

19. Allergic swelling (angioedema) followed by forceful self‑compression

20. Poorly fitted intubation tubes causing focal pressure Verywell HealthMayo Clinic.

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Symptoms

Patients with hyoglossus strains may experience:

1. Localized tongue pain, especially when depressed

2. Swelling under the tongue or floor of mouth

3. Difficulty retracting the tongue

4. Impaired tongue elevation or lateral movement

5. Bruising (ecchymosis) on sublingual tissues

6. Tenderness on palpation of the hyoglossal region

7. Hematoma formation at the injury site

8. Altered speech articulation (dysarthria)

9. Difficulty swallowing (dysphagia)

10. Sensation of a “tight” tongue

11. Tongue deviation toward the injured side

12. Reduced range of tongue motion

13. Muscle spasms felt deep in the floor of mouth

14. Audible clicking or snapping with tongue movement

15. Mild fever if secondary inflammation develops

16. Dry mouth due to guarding behavior

17. Voice changes from altered resonance

18. Submandibular pain referral

19. Difficulty keeping the tongue on lower teeth for rest

20. Generalized oral discomfort exacerbated by talking Mayo ClinicWikipedia.

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Diagnostic Tests

Evaluation involves both clinical and imaging modalities:

1. Detailed oral and submandibular physical examination

2. Inspection for asymmetry or swelling

3. Palpation of the hyoglossal area for tenderness

4. Manual assessment of tongue depression strength

5. Range‑of‑motion testing for tongue protrusion/retraction

6. Ultrasound of the sublingual region to detect fiber disruption

7. MRI of the floor of mouth for soft‑tissue contrast

8. CT scan to evaluate associated bony or hyoid injury

9. Electromyography (EMG) to assess muscle electrical activity

10. Nerve conduction studies of hypoglossal nerve

11. Fiberoptic endoscopic evaluation during swallowing

12. Videofluoroscopic swallowing study

13. Ultrasound‑guided palpation for hematoma detection

14. Blood tests for inflammatory markers (e.g., ESR, CRP)

15. Coagulation profile if unexplained hematoma formation

16. Pain and functional severity scoring (VAS, FOSS)

17. Laryngeal electromyography if dysphagia severe

18. Sialometry to rule out salivary gland involvement

19. Ultrasound elastography for tissue stiffness

20. Differential diagnosis via ENT consultation to exclude other pathologies RadiopaediaWikipedia.

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Non‑Pharmacological Treatments

A multimodal rehabilitation approach is key:

1. Rest of tongue movements Mayo Clinic

2. Ice packs to sublingual area (15–20 min every 2–3 h)

3. Compression with gentle intraoral pressure via gauze

4. Elevation of head during rest to reduce swelling

5. Warm‑up tongue stretches before speech exercises

6. Soft‑food diet to minimize mechanical stress

7. Speech therapy focusing on gentle movements

8. Manual massage of floor‑of‑mouth tissues

9. Ultrasound therapy for deep heat application

10. Laser therapy to accelerate tissue healing

11. Dry needling targeting trigger points

12. Kinesiology taping under the chin for support

13. Biofeedback during tongue strengthening

14. Electrical muscle stimulation for low‑grade activation

15. Isometric tongue exercises progressing in intensity

16. Progressive resistance stretches in therapy

17. Transcutaneous electrical nerve stimulation (TENS)

18. Aerobic conditioning to enhance overall circulation

19. Hydrotherapy mouth rinses at alternating temperatures

20. Ultrasound‑guided aspiration of large hematomas

21. Platelet‑rich plasma (PRP) injections to boost healing

22. Hyperbaric oxygen therapy for severe cases

23. Vitamin supplementation (C, D, E) for tissue repair

24. Hydration optimization to maintain tissue pliability

25. Ergonomic mouth guard in sports to prevent further trauma

26. Cognitive‑behavioral strategies to manage pain perception

27. Mindfulness breathing to reduce oral muscle tension

28. Acupuncture focused on orofacial points

29. Low‑level laser therapy (LLLT) to reduce inflammation

30. Gradual return‑to‑function protocol under therapist guidance WikipediaMayo Clinic.

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Pharmacological Treatments

Medication choices mirror general muscle strain management:

1. Ibuprofen (NSAID) Mayo ClinicMayo Clinic News Network

2. Naproxen (NSAID) Mayo Clinic News Network

3. Aspirin (NSAID) Cleveland Clinic

4. Diclofenac (topical gel) Mayo Clinic

5. Meloxicam (prescription NSAID) Cleveland Clinic

6. Celecoxib (COX‑2 inhibitor) Cleveland Clinic

7. Acetaminophen (analgesic) Mayo Clinic

8. Cyclobenzaprine (muscle relaxant) Verywell Health

9. Tizanidine (muscle relaxant) Verywell Health

10. Methocarbamol (muscle relaxant) Verywell Health

11. Prednisone (short‑course corticosteroid) Mayo Clinic

12. Methylprednisolone (corticosteroid) Mayo Clinic

13. Lidocaine (topical anesthetic) Mayo Clinic

14. Benzocaine (oral gel) Mayo Clinic

15. Diclofenac‑lidocaine patch Mayo Clinic

16. Opioid combinations (e.g., oxycodone‑acetaminophen) for severe pain under strict supervision

17. Gabapentin (for neuropathic component)

18. Tramadol (if NSAIDs contraindicated)

19. Capsaicin cream (topical counter‐irritant)

20. Orphenadrine (muscle relaxant) Verywell Health.

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Surgical Interventions

Reserved for Grade III or complicated cases:

1. Open muscle repair of torn hyoglossus fibers

2. Hematoma evacuation in the floor of mouth

3. Microvascular muscle grafting for extensive loss

4. Ligation of bleeding vessels under direct vision

5. Debridement of necrotic muscle tissue

6. Hypoglossal nerve decompression if nerve entrapment

7. Sublingual space exploration for foreign bodies

8. Flap reconstruction using local mucosal tissue

9. Fasciotomy for compartment syndrome of sublingual space

10. Endoscopic-assisted repair for minimally invasive approach Mayo Clinic.

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Prevention Strategies

Proactively reducing risk of hyoglossus injury:

1. Gentle warm‑up exercises before intensive tongue therapy

2. Use of protective intraoral guards in contact sports

3. Proper technique during oral intubation and endoscopy

4. Controlled stretching protocols under supervision

5. Hydration maintenance to optimize muscle resilience

6. Avoidance of sharp instruments near the floor of mouth

7. Gradual progression of speech therapy intensity

8. Regular dental checkups to prevent accidental biting

9. Protective behaviors during seizures (e.g., mouth guards)

10. Patient education on early recognition and self‑care OrthoInfo.

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When to See a Doctor

Seek professional evaluation if you experience:

• Persistent or worsening pain beyond 3–5 days despite home care

• Difficulty breathing or swallowing

• Progressive weakness of tongue function

• Numbness or tingling in the tongue

• Rapidly expanding swelling or hematoma

• Signs of infection (fever, redness, warmth)

• Inability to manage oral secretions Mayo ClinicMayo Clinic.

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Frequently Asked Questions

1. What exactly is the hyoglossus muscle?
   The hyoglossus is one of the four extrinsic muscles of the tongue. It connects the hyoid bone to the side of the tongue and helps depress and retract it Wikipedia.

2. Why is a “sprain” used instead of “strain” for a muscle?
   In strict medical terms, muscles suffer strains and ligaments suffer sprains. Yet in common usage, both terms sometimes overlap when describing soft‑tissue injuries Verywell Health.

3. How long does a hyoglossus strain take to heal?
   Healing time ranges from 1–3 weeks for mild (Grade I) injuries to several months for severe (Grade III) cases.

4. Can I still eat and speak with a hyoglossus strain?
   Mild pain may allow soft-food intake and gentle speech. Severe strains may require a modified diet and limited talking.

5. Are imaging tests always necessary?
   Imaging (ultrasound or MRI) is recommended for moderate to severe injuries or if diagnosis is uncertain.

6. Will surgery always be needed for Grade III injuries?
   Most complete tears (Grade III) require surgical repair to restore muscle continuity and function.

7. Can I prevent future strains?
   Yes—through proper warm‑up, controlled stretching, and protective devices in high‑risk activities OrthoInfo.

8. Is physical therapy helpful?
   Absolutely. Targeted speech and swallowing therapy speeds functional recovery and reduces stiffness.

9. Do NSAIDs slow healing?
   Short‑term NSAID use is safe; prolonged use (beyond 2 weeks) may marginally delay muscle regeneration.

10. Can I use heat instead of ice?
    Ice is preferred initially (first 48 h). Heat may be applied afterwards to improve circulation.

11. Are injections like PRP effective?
    Platelet‑rich plasma shows promise for accelerating healing, but evidence is still emerging.

12. Could a hyoglossus strain affect taste?
    Taste function typically remains intact, as taste buds and nerves are not directly involved.

13. Is acupuncture beneficial?
    Acupuncture may help reduce pain perception but should complement, not replace, conventional therapy.

14. What about home remedies?
    Proper rest, ice, and gentle stretching at home form the cornerstone of self‑care in mild cases.

15. When is referral to a specialist required?
    Persistent dysfunction beyond 2 weeks, suspected nerve involvement, or complex surgical needs warrant ENT or oral‑maxillofacial consultation

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Last Updated: April 18, 2025.