Hyoglossus Muscle Tears

A hyoglossus muscle tear is an injury in which the extrinsic tongue muscle called the hyoglossus sustains damage ranging from mild fiber stretching to complete rupture. This muscle lies deep in the floor of the mouth and plays a vital role in pulling the tongue downward and backward. Tears can occur due to trauma, overuse, or iatrogenic causes (medical procedures), and they often lead to pain, swelling, and difficulty moving the tongue. Though uncommon, early recognition and appropriate management are essential to preserve tongue function for speech, swallowing, and airway protection DynaMedWikipedia.

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Anatomy

Structure and Location

The hyoglossus is a thin, quadrilateral extrinsic muscle of the tongue situated in the floor of the oral cavity. It forms part of the submandibular triangle and lies immediately lateral to the geniohyoid muscle, deep to the submandibular gland and duct. Its broad base is anchored on the hyoid bone, while its fibers ascend almost vertically toward the side of the tongue NCBIRadiopaedia.

Origin

The muscle originates along the entire length of the hyoid bone’s body and greater cornu. Fibers from the body overlap those from the greater cornu, creating a wide attachment that provides stable support for tongue movements NCBIEncyclopedia Britannica.

Insertion

Fibers of the hyoglossus pass almost vertically upward to insert into the lateral aspect of the tongue, between the styloglossus muscle laterally and the inferior longitudinal intrinsic muscle medially. This strategic insertion allows the muscle to exert downward and backward traction on the tongue surface RadiopaediaWikipedia.

Blood Supply

The primary vascular supply to the hyoglossus arises from the sublingual branch of the lingual artery, with additional contributions from the submental branch of the facial artery. This rich blood flow supports muscle metabolism and repair after injury NCBIRadiopaedia.

Nerve Supply

Motor innervation is provided exclusively by the hypoglossal nerve (cranial nerve XII). This nerve delivers signals that enable the hyoglossus to contract and coordinate with other tongue muscles for precise movements Cleveland ClinicWikipedia.

Functions

The hyoglossus muscle performs several key functions:

1. Depresses the tongue body, flattening its surface.

2. Retracts the tongue backward toward the oropharynx.

3. Depresses the lateral margins of the tongue, affecting its contour.

4. Contributes to making the dorsum (upper surface) of the tongue more convex.

5. Aids in swallowing by pulling the tongue base down, facilitating the passage of food.

6. Assists in speech articulation by fine-tuning tongue shape and position. KenhubNCBI.

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Types of Hyoglossus Muscle Tears

Muscle tears are classified by severity into three grades:

Grade I (Mild strain): Involves overstretching or minor tearing of a few muscle fibers. Pain is often mild, there is minimal swelling, and range of motion remains nearly normal. Activities may continue with slight discomfort Hospital for Special SurgeryPMC.

Grade II (Moderate strain): Characterized by partial tearing of more muscle fibers without complete rupture. Patients experience moderate pain, noticeable swelling or bruising, and reduced strength and motion. Daily activities and speaking or swallowing may be impaired Hospital for Special SurgeryPMC.

Grade III (Severe strain/complete tear): Represents a full-thickness tear or avulsion of the muscle from its attachment. Severe pain, significant swelling, a palpable gap in the muscle, and complete loss of function occur. Surgical repair is often required Hospital for Special SurgeryPMC.

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Causes

The following factors can lead to hyoglossus muscle tears:

• Direct blunt trauma to the mouth (e.g., blows, falls)

• Tongue biting during seizures or convulsions

• Sports-related injuries (e.g., impact from balls or athletic gear)

• Iatrogenic injury during orotracheal intubation

• Surgical trauma in head and neck operations

• Dental procedures involving forceps or drills

• Fish or bone fragments piercing the tongue

• Penetrating injuries (e.g., stabbing, sharp object lacerations)

• Motor vehicle accidents with facial impact

• Work-related accidents (e.g., industrial machinery)

• Repeated tongue thrusting or protrusion (overuse)

• Bulky food bolus lodging and forceful removal

• Tongue ring or piercing complications

• Radiation therapy causing tissue fragility

• Infection-related tissue breakdown (e.g., abscess drainage)

• Neuromuscular disorders causing uncontrolled tongue movements

• Collagen vascular diseases weakening muscle integrity

• Aging-related loss of muscle elasticity

• Nutritional deficiencies impairing muscle repair

• Sudden, forceful coughing or retching reflex WikipediaDynaMed

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Symptoms

Common signs and symptoms of hyoglossus muscle tears include:

1. Sudden or gradual onset tongue pain

2. Localized swelling on the side of the tongue

3. Bruising or hematoma formation

4. Palpable gap or defect in tongue muscle

5. Difficulty protruding or retracting the tongue

6. Weakness when pushing tongue against cheek

7. Speech slurring or articulation problems

8. Trouble swallowing (dysphagia)

9. Excessive drooling (sialorrhea)

10. Bleeding from the laceration site

11. Numbness or altered sensation if nerve involvement

12. Muscle spasm or cramping

13. Reduced tongue range of motion

14. Pain aggravated by movement or talking

15. Visible deformity or indentation

16. Sensation of a “snapping” at injury moment

17. Hoarseness or voice changes

18. Difficulty clearing saliva

19. Taste disturbance (rare)

20. Secondary infection signs (redness, warmth, fever) WikipediaDynaMed

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Diagnostic Tests

To assess a suspected hyoglossus tear, clinicians may employ:

1. Detailed history and physical exam (inspection, palpation)

2. Tongue strength testing against resistance

3. Range of motion assessment

4. Fiberoptic endoscopic evaluation of swallowing

5. Ultrasonography of tongue muscles

6. Magnetic resonance imaging (MRI) for soft‑tissue detail

7. Computed tomography (CT) scan if complex trauma is suspected

8. Plain radiographs to exclude bony injury

9. Electromyography (EMG) for muscle activation patterns

10. Nerve conduction studies (NCS) for hypoglossal nerve

11. Videofluoroscopic swallow study

12. Flexible laryngoscopy for airway visualization

13. Tongue surface biopsy in chronic nonhealing tears

14. Blood tests (CK levels) for muscle injury markers

15. Ultrasound elastography to gauge tissue stiffness

16. Dynamic ultrasound during tongue movement

17. Local anesthetic injection test to isolate pain source

18. Contrast-enhanced CT/MRI for hematoma evaluation

19. Microvascular Doppler to assess blood flow

20. Clinical photography for documentation and monitoring RSNA PublicationsNCBI

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Non‑Pharmacological Treatments

Conservative measures form the cornerstone of initial management:

1. Rest and avoidance of tongue strain

2. Ice application to reduce swelling (10–15 min intervals)

3. Warm compresses after acute phase

4. Soft diet to minimize tongue movement

5. Placement of a bite guard to prevent self‑injury

6. Speech therapy exercises for mobility

7. Swallowing therapy (dysphagia rehab)

8. Gentle tongue stretching maneuvers

9. Manual myofascial release by trained therapists

10. Moist heat packs to promote circulation

11. Ultrasonic therapy for tissue healing

12. Low-level laser therapy (LLLT)

13. Extracorporeal shockwave therapy (ESWT)

14. Targeted massage and soft‑tissue mobilization

15. Electrical muscle stimulation (EMS)

16. Acupuncture for pain relief

17. Dry needling of trigger points

18. Biofeedback‑guided movement training

19. Proprioceptive neuromuscular facilitation (PNF)

20. Kinesio taping to support muscle alignment

21. Platelet-rich plasma (PRP) injections

22. Nutritional optimization (protein, vitamins)

23. Adequate hydration for muscle metabolism

24. Ergonomic advice to avoid repetitive strain

25. Use of protective mouthguards during sports

26. Behavioral strategies to prevent tongue biting

27. Progressive resistance exercises

28. Yoga and gentle stretching for neck and jaw

29. Transcutaneous electrical nerve stimulation (TENS)

30. Ultrasound-guided percutaneous needle tenotomy WikipediaCleveland Clinic

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Pharmacological Treatments

Medication can alleviate pain and support healing:

1. Ibuprofen (NSAID) for pain and inflammation

2. Naproxen (NSAID)

3. Aspirin (low-dose for analgesia)

4. Acetaminophen (paracetamol) for pain

5. Diclofenac gel (topical NSAID)

6. Lidocaine gel/lozenges for local analgesia

7. Cyclobenzaprine (muscle relaxant)

8. Tizanidine (muscle relaxant)

9. Oral corticosteroids (short course)

10. Prednisone taper for severe inflammation

11. Gabapentin for neuropathic pain

12. Tramadol for moderate to severe pain

13. Codeine‑acetaminophen combination

14. Amitriptyline for chronic pain modulation

15. Baclofen for spasm control

16. Botulinum toxin injection in refractory spasm

17. Topical capsaicin cream

18. NSAID mouthwash (ketorolac)

19. Calcium channel blockers (nifedipine for pain vasodilation)

20. Platelet‑derived growth factor injections WikipediaCleveland Clinic

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Surgical Treatments

When conservative care fails or for complete ruptures, surgery may include:

1. Primary suture repair of muscle tear

2. Debridement of necrotic tissue

3. Fascial graft to reinforce repair

4. Free muscle flap transfer for large defects

5. Microsurgical hypoglossal nerve repair

6. Neurotization (nerve grafting)

7. Tongue base reconstruction

8. Surgical drainage of hematoma

9. Revision surgery for chronic nonunion

10. Implantation of tongue‑stabilizing devices DynaMedHospital for Special Surgery

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Prevention Strategies

To reduce the risk of hyoglossus tears:

1. Wear custom mouthguards in contact sports

2. Practice safe swallowing techniques

3. Avoid pen chewing and tongue rings

4. Use caution during dental work and intubation

5. Warm up before activities requiring intense tongue use

6. Manage seizure disorders effectively

7. Ensure proper nutrition and hydration

8. Control chronic cough or retching

9. Use protective face gear in high‑risk occupations

10. Schedule regular dental and ENT evaluations WikipediaDynaMed

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When to See a Doctor

Seek immediate medical attention if you experience:

• Severe pain that doesn’t improve with over‑the‑counter treatment

• Profuse bleeding or expanding hematoma

• Inability to move or control the tongue

• Signs of infection (fever, redness, warmth)

• Difficulty breathing or choking sensations

• Persistent numbness or altered sensation

• Visible gap or indentation in the tongue

• Speech or swallowing suddenly worsens

• Trauma involving foreign bodies

• Symptoms lasting more than 48 hours WikipediaDynaMed

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Frequently Asked Questions

1. What is a hyoglossus muscle tear?
   A tear of the hyoglossus muscle is when its fibers stretch or rupture, typically causing pain, swelling, and trouble moving the tongue. WikipediaDynaMed

2. How do I know if I have a hyoglossus tear?
   Look for sudden tongue pain, visible swelling or bruising, and difficulty protruding or retracting your tongue. A healthcare provider can confirm with an exam and imaging. WikipediaNCBI

3. Can a mild hyoglossus tear heal on its own?
   Grade I tears often improve with rest, ice, and gentle exercises within 2–4 weeks if managed properly. Hospital for Special SurgeryPMC

4. When is surgery necessary?
   Surgical repair is considered for Grade III complete ruptures or when conservative treatment fails after several weeks. Hospital for Special SurgeryDynaMed

5. Will a hyoglossus tear affect my speech?
   Yes, because the hyoglossus helps shape the tongue for consonant sounds and retraction; weakness can cause slurred speech. Cleveland ClinicWikipedia

6. Is swallowing permanently affected?
   Most patients regain normal swallowing with therapy; severe or neglected tears can lead to lasting dysphagia. DynaMedNCBI

7. How long does recovery take?
   Recovery ranges from 2 weeks for mild strains to 3–6 months for severe tears or post‑surgical healing. Cleveland ClinicPMC

8. Can I prevent a tear if I have seizures?
   Yes, using bite guards and keeping seizure activity under control reduces risk of tongue biting injuries. WikipediaDynaMed

9. Are there exercises to strengthen the hyoglossus?
   Speech and swallow therapists can guide gentle tongue depression and retraction exercises to rebuild strength. Hospital for Special SurgeryKenhub

10. What medications help with pain?
    Over‑the‑counter NSAIDs like ibuprofen or acetaminophen relieve pain and reduce inflammation. Prescription muscle relaxants may be used for spasms. WikipediaCleveland Clinic

11. Is imaging always required?
    Mild strains may only need clinical evaluation, but ultrasound or MRI is recommended if a tear is suspected or symptoms persist. RSNA PublicationsNCBI

12. Can nerve damage occur with a hyoglossus tear?
    Rarely, severe trauma may injure the hypoglossal nerve, leading to tongue paralysis and deviation. NCBIPhysiopedia

13. Will physical therapy alone suffice?
    For Grade I–II tears, a combination of rest, therapy, and modality treatments like ultrasound often achieves full recovery. Cleveland ClinicPMC

14. Are there long‑term complications?
    Chronic weakness, scar tissue formation, and mild speech or swallowing changes can persist if treatment is delayed. PMCScienceDirect

15. How can I find a specialist?
    Seek evaluation by an ENT surgeon, maxillofacial specialist, or speech‑language pathologist experienced in tongue muscle injuries.

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Last Updated: April 18, 2025.