Tongue Superior Longitudinal Muscle Cancer

Anatomy of the Superior Longitudinal Muscle
Types of Tongue Superior Longitudinal Muscle Cancer
Causes (Risk Factors)
Symptoms
Diagnostic Tests
Non‑Pharmacological Treatments
Drugs
Surgeries
Preventive Measures
When to See a Doctor
Frequently Asked Questions (FAQs)

A rare form of oral cancer in which malignant (cancer) cells originate in—or invade—the superior longitudinal muscle of the tongue, one of the intrinsic tongue muscles that lie just beneath the mucous membrane on the dorsum of the tongue. These cancers are most often squamous cell carcinomas that first arise in the mucosal lining and then spread into the deeper muscle fibers, including the superior longitudinal muscle, leading to local invasion and potential spread to lymph nodes and beyond .

Anatomy of the Superior Longitudinal Muscle

Structure and Location

The superior longitudinal muscle is a thin, broad layer of oblique and longitudinal fibers immediately under the mucosa of the tongue’s dorsal (top) surface. Its central portion is relatively thick, tapering toward the sides of the tongue .

Origin

It arises from the submucous fibrous layer close to the epiglottis and from the median fibrous septum in the tongue’s midline .

Insertion

Its fibers run forward and insert into the lateral margins (edges) of the tongue, extending from the epiglottic region all the way to the tip .

Blood Supply

The muscle receives arterial blood mainly from the sublingual branch of the lingual artery, a branch of the external carotid artery, ensuring a rich blood flow for muscle function .

Nerve Supply

Motor innervation is supplied by the hypoglossal nerve (cranial nerve XII), which controls the intrinsic and most extrinsic muscles of the tongue .

Functions

Shortening the tongue: Contracts to make the tongue shorter and thicker .
Widening the tongue: When it shortens, the tongue also becomes wider .
Dorsiflexion (upward curl): Elevates the tongue tip toward the palate .
Concaving the dorsum: Creates a trough shape for swallowing .
Retracting the tongue: Works with the inferior longitudinal muscle to pull the tongue back .
Speech articulation: Alters tongue shape for precise speech sounds .

Types of Tongue Superior Longitudinal Muscle Cancer

Oral (oral‑tongue) squamous cell carcinoma: Most common type, arises on the front two‑thirds of the tongue .
Base‑of‑tongue squamous cell carcinoma: Arises in the posterior one‑third of the tongue near the throat .
Verrucous carcinoma: A slow‑growing, warty variant of squamous cell carcinoma .
Basaloid squamous carcinoma: A more aggressive squamous cell variant .
Spindle cell carcinoma: Characterized by elongated cancer cells .
Adenosquamous carcinoma: Contains both gland‑forming and squamous elements .
Minor salivary gland carcinoma (e.g., mucoepidermoid): Rare salivary gland tumors in tongue muscle .
Melanoma: Rare malignant tumor of pigment cells in the tongue .
Sarcomas (e.g., leiomyosarcoma): Rare muscle‑origin tumors in the tongue .
Lymphoma: Rarely involves intrinsic tongue muscle .

Causes (Risk Factors)

Tobacco smoking: Carcinogens in tobacco damage tongue cell DNA over time .
Chewing tobacco (snuff): Direct contact with carcinogens on tongue lining .
Excessive alcohol use: Alcohol metabolites act as local carcinogens .
Human papillomavirus (HPV) infection: High‑risk HPV types 16/18 linked to oropharyngeal cancers .
Poor oral hygiene: Chronic inflammation and infection risk .
Chronic mechanical irritation: Sharp teeth or dental work rubbing mucosa .
Betel nut chewing: Common in South Asia, a known carcinogen PMC.
Immunosuppression: HIV/AIDS or post‑transplant therapy increases cancer risk .
Age over 50: Cumulative exposure to risk factors .
Male gender: Higher incidence historically, though gap is closing .
Diet low in fruits and vegetables: Lacking protective antioxidants Mayo Clinic.
Oral lichen planus: Chronic inflammatory condition of mucous membranes PMC.
Plummer‑Vinson syndrome: Iron‑deficiency anemia with mucosal atrophy .
Previous head and neck radiation: Increases secondary cancer risk .
Genetic predisposition: Family history of head and neck cancers .
Epstein‑Barr virus (EBV): Rare association with certain oral malignancies .
Syphilis (tertiary): Chronic ulceration risk .
Chronic candidiasis: Long‑standing fungal infection may predispose Cancer Resources.
Occupational exposures: Wood dust, formaldehyde, or asbestos .
Poorly fitting dentures: Chronic irritation and mucosal damage PMC.

Symptoms

Non‑healing sore: A sore on the tongue that doesn’t heal in 2 weeks .
Persistent tongue pain: Unexplained pain or tenderness .
Bleeding: Sore or ulcer bleeds easily when touched .
Lump or thickening: Firm area felt on the tongue surface .
Red or white patches: Erythroplakia or leukoplakia on the tongue .
Difficulty swallowing (dysphagia): Food feels stuck .
Painful swallowing (odynophagia): Sharp pain when swallowing .
Ear pain (referred): Pain radiates to the ear without ear pathology .
Voice changes: Hoarseness or altered speech .
Tongue numbness: Loss of sensation .
Difficulty moving tongue: Impaired speech or eating .
Weight loss: Unexplained weight loss from pain or swallowing issues .
Drooling: Excessive saliva due to reduced tongue control .
Halitosis (bad breath): Secondary to ulceration or infection .
Jaw swelling: Involvement of underlying tissues .
Neck lump: Palpable lymph node enlargement .
Oral ulcer: Persistent ulcer not healing .
Stiffness of jaw: Trismus from muscle invasion .
Cough or blood in saliva: Advanced mucosal ulceration .
Fever: Rare, usually secondary to infection .

Diagnostic Tests

Physical exam: Inspection and palpation of tongue and neck .
Biopsy (incisional/punch): Tissue sample for histology .
Fine‑needle aspiration (FNA): Sampling enlarged lymph nodes .
Direct laryngoscopy: Visualize base of tongue and throat .
MRI scan: Detailed soft‑tissue imaging for invasion depth .
CT scan: Assess bone invasion and staging .
PET‑CT scan: Detect regional/distant metastases .
Ultrasound of neck: Evaluate lymph nodes .
Chest X‑ray: Check for lung metastasis .
Endoscopic ultrasound: Assess local spread .
Panendoscopy: Examine entire upper aerodigestive tract .
Barium swallow: Evaluate swallowing function .
Blood tests (CBC, LFTs): General health and baseline .
HPV testing (p16 IHC): Identify HPV‑related tumors .
EBV serology: Rarely used, but for differential .
Salivary biomarker assays: Research tool for early detection ScienceDirect.
Depth of invasion measurement: Histologic measurement predicts prognosis .
Muscle invasion assessment: Histologic landmark for staging .
Sentinel lymph node biopsy: Evaluate occult nodal spread .
Immunohistochemistry panels: Characterize tumor markers .

Non‑Pharmacological Treatments

Smoking cessation programs: Behavioral support to quit tobacco .
Alcohol moderation counseling: Reduce alcohol‑related mucosal damage .
Nutritional counseling: Diet planning to maintain weight and healing Cancer Resources.
Oral hygiene protocols: Regular cleaning to prevent infections PMC.
Speech therapy: Improve articulation post‑treatment ScienceDirect.
Swallowing therapy: Exercises to restore safe swallowing ScienceDirect.
Physical therapy: Tongue and neck exercises to maintain mobility ScienceDirect.
Occupational therapy: Adaptive strategies for eating and speaking ScienceDirect.
Psychological counseling: Emotional support for coping ScienceDirect.
Support groups: Peer support for shared experiences Patient Care at NYU Langone Health.
Mindfulness and meditation: Stress reduction techniques ScienceDirect.
Yoga and gentle exercise: Improve well‑being and reduce fatigue Patient Care at NYU Langone Health.
Massage therapy: Relief of neck tension and stress PMC.
Acupuncture: May help with dry mouth and discomfort Patient Care at NYU Langone Health.
Aromatherapy: Relaxation aid, though evidence is limited PMC.
Music or art therapy: Distraction and emotional relief Verywell Health.
Guided imagery and relaxation: Cognitive strategies to reduce anxiety PMC.
Hypnosis: May assist in pain and anxiety control PMC.
Prosthetic rehabilitation: Palatal augmentation or speech devices PMC.
Feeding tube support: Non‑oral nutrition to maintain intake Cancer Resources.
Oral cryotherapy: Ice chips to reduce mucositis during treatment PMC.
Low‑level laser therapy: For radiation‑induced mucositis ScienceDirect.
Hyperbaric oxygen therapy: Promote healing of irradiated tissues ScienceDirect.
TENS (Transcutaneous Electrical Nerve Stimulation): Non‑drug pain relief PMC.
Guided nutrition supplements: Use of high‑protein shakes (non‑drug) Cancer Resources.
Oropharyngeal exercises: Improve muscle strength for swallowing PMC.
Regular dental evaluations: Early management of oral complications PMC.
Custom mouthguards: Protect mucosa during radiotherapy Memorial Sloan Kettering Cancer Center.
Saline mouth rinses: Keep mucosa clean and moist Memorial Sloan Kettering Cancer Center.
Gentle massage of salivary glands: Stimulate saliva flow Memorial Sloan Kettering Cancer Center.

Drugs

Cisplatin: Platinum‑based chemotherapy for advanced disease Mayo Clinic.
5‑Fluorouracil (5‑FU): Pyrimidine analog disrupting DNA synthesis Mayo Clinic.
Carboplatin: Alternative platinum agent with similar action Cancer Research UK.
Paclitaxel: Microtubule inhibitor used in combination regimens Cancer Research UK.
Docetaxel: Taxane chemotherapy for recurrent disease Cancer Research UK.
Methotrexate: Low‑dose therapy for palliative care Cancer Research UK.
Bleomycin: Glycopeptide antibiotic with antitumor activity Cancer Research UK.
Capecitabine: Oral prodrug of 5‑FU Cancer Research UK.
Cetuximab (Erbitux): EGFR‑targeted monoclonal antibody Verywell Health.
Pembrolizumab (Keytruda): PD‑1 immune checkpoint inhibitor Cancer Research UK.
Nivolumab (Opdivo): Another PD‑1 inhibitor for recurrent disease Cancer Research UK.
Afatinib: EGFR tyrosine kinase inhibitor Cancer Research UK.
Erlotinib: EGFR inhibitor used off‑label in head and neck cancers Cancer Research UK.
Docetaxel + Cisplatin (TP regimen): Combination for induction therapy Cancer Research UK.
Hydroxyurea: Occasionally used in palliative settings Cancer Research UK.
Vincristine: Vinca alkaloid in some combined regimens Cancer Research UK.
Mitomycin C: Antitumor antibiotic in chemoradiation Cancer Research UK.
Oxaliplatin: Alternative platinum agent under study Cancer Research UK.
Leucovorin: Folinic acid to enhance 5‑FU effects Cancer Research UK.
Topotecan: Topoisomerase inhibitor for relapsed disease Cancer Research UK.

Surgeries

Wide local excision: Remove the tumor with margins Cancer Research UK.
Partial glossectomy: Remove part of the tongue affected by cancer Cancer Research UK.
Hemiglossectomy: Removal of one side (half) of the tongue Cancer Research UK.
Subtotal glossectomy: Remove most of the mobile tongue Cancer Research UK.
Total glossectomy: Complete removal of the tongue Mayo Clinic.
Neck dissection: Removal of lymph nodes in the neck Cancer Research UK.
Sentinel lymph node biopsy: Minimal nodal assessment technique .
Reconstructive flap surgery: Free flap (e.g., radial forearm) reconstruction Cancer Research UK.
Tracheostomy: Secure airway in advanced cases PMC.
Feeding tube placement (gastrostomy or nasogastric): Ensure nutrition during recovery Cancer Resources.

Preventive Measures

Avoid tobacco: Complete abstinence from smoking/chewing Mayo Clinic.
Limit alcohol: Stay within recommended guidelines Mayo Clinic.
HPV vaccination: Protect against high‑risk HPV types .
Maintain good oral hygiene: Regular brushing and flossing PMC.
Regular dental check‑ups: Early detection of precancerous lesions PMC.
Healthy diet: High in fruits, vegetables, and antioxidants Mayo Clinic.
Protect lips from sun: Use sunscreen or lip balm with SPF Mayo Clinic.
Treat oral lesions early: Manage lichen planus, leukoplakia promptly .
Avoid betel nut: Cease use of areca nut products PMC.
Manage acid reflux: Reduce chronic mucosal irritation .

When to See a Doctor

See a healthcare professional if you have any persistent tongue sore, lump, patch, pain, or difficulty swallowing lasting more than two weeks. Early evaluation and biopsy can lead to prompt diagnosis and better outcomes .

Frequently Asked Questions (FAQs)

What causes cancer in the tongue’s superior longitudinal muscle?
Cancer typically begins in the mucosal lining (squamous cells) and then invades the underlying muscle, including the superior longitudinal muscle, through expansion of malignant cells .
How is superior longitudinal muscle cancer different from other tongue cancers?
Its hallmark is direct invasion into the intrinsic muscle layer, which may affect tongue mobility and prognosis .
Can this cancer spread to lymph nodes?
Yes. Muscle invasion is a key factor for lymphatic spread; neck dissection often checks for node involvement .
Is biopsy painful?
Local anesthesia is used, so most patients feel only minimal discomfort during tissue sampling .
What imaging is best for staging?
MRI provides superior soft‑tissue detail; PET‑CT is useful for detecting distant metastases .
Does HPV‑positive status affect treatment?
HPV‑positive tumors often respond better to therapy and may have a better prognosis .
Can surgery alone cure early cases?
Early-stage tumors confined to the mucosa and muscle can often be cured with surgery alone .
What are common side effects of treatment?
Side effects include pain, difficulty swallowing, dry mouth, and changes in taste; supportive care helps manage them Cancer Resources.
Is radiotherapy considered non‑drug?
Yes, radiotherapy uses ionizing radiation rather than medications, so it’s classified as non‑pharmacological Cancer Research UK.
How long is recovery after glossectomy?
Recovery varies by extent of surgery but often takes several weeks with rehabilitation for speech and swallowing PMC.
Can I still speak after partial glossectomy?
Yes, with speech therapy most patients regain functional speech, though articulation may change slightly ScienceDirect.
Will I need a feeding tube?
A temporary tube may be required if swallowing is too painful; many patients transition back to oral feeding Cancer Resources.
Are there genetic tests for risk?
No routine genetic tests are available; family history may prompt closer monitoring .
How can I reduce recurrence risk?
Quit tobacco/alcohol, maintain oral hygiene, attend regular follow‑up visits Mayo Clinic.
What is the long‑term outlook?
Five‑year survival rates vary by stage: ~80% for localized, ~50% for regional, and ~30% for distant spread .

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

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

Last Updated: April 22, 2025.

References

SaveSavedRemoved 0