Inferior Longitudinal Muscle Tear

An inferior longitudinal muscle tear is a partial or complete rupture of one of the tongue’s intrinsic muscles, specifically the band of fibers on the tongue’s underside that shortens and curls the tip downward. Tears may occur suddenly (acute) or develop over time (chronic), and can impair speech, swallowing, and tongue shape.

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Anatomy

Structure & Location.
The inferior longitudinal muscle is one of four intrinsic tongue muscles entirely within the tongue mass, lying beneath the transverse and superior longitudinal layers, between the genioglossus and hyoglossus muscles RadiopaediaWikipedia.

Origin.
Fibers originate proximally from the root of the tongue near the hyoid bone and the body of the tongue Radiopaedia.

Insertion.
Distally, fibers insert into the apex (tip) of the tongue, blending with other intrinsic fibers to modulate tip movement Kenhub.

Blood Supply.
Branches of the lingual artery, especially the deep lingual artery, supply the muscle with oxygenated blood Radiopaedia.

Nerve Supply.
Motor innervation is via the hypoglossal nerve (cranial nerve XII), which controls all intrinsic tongue muscles Wikipedia.

Functions.

1. Shortening the tongue body.

2. Widening the tongue.

3. Curling the tip downward (ventroflexion).

4. Assisting retraction of the tongue.

5. Forming central groove for food manipulation.

6. Contributing to speech articulation by fine shape control NCBIKenhub.

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Types of Tears

Muscle tears are classified by severity into grades based on fiber disruption and function loss:

• Grade I (Mild): Few fibers stretched or micro-tears; normal strength and range of motion PhysiopediaCleveland Clinic.

• Grade II (Moderate): Partial tear of many fibers; decreased strength, swelling, possible bruising.

• Grade III (Severe): Complete rupture through the muscle; significant loss of function and often requires surgical repair Hospital for Special SurgeryNationwide Children’s Hospital.

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 Causes

Injuries to the inferior longitudinal muscle often share mechanisms with other muscle strains, with additional tongue-specific factors:

1. Accidental tongue biting during falls or seizures My Health Alberta

2. Sports-related blunt trauma (e.g., ball strikes) Cleveland Clinic

3. Motor vehicle accidents causing oral contusion

4. Fights or assaults with oral impact

5. Dental procedures (tooth extraction, braces adjustments)

6. Oral surgery (biopsies, tumor resections)

7. Endotracheal intubation injury during anesthesia

8. Sharp tongue piercings or jewellery

9. Orthodontic wire lacerations

10. Overextension beyond anatomical limits (unusual stretching)

11. Direct penetrating trauma (e.g., fish bone)

12. Radiation therapy–induced tissue fragility

13. Myositis or inflammatory muscle disease

14. Muscular dystrophies weakening fibers over time

15. Amyotrophic lateral sclerosis leading to muscle degeneration

16. Iatrogenic needle injury during injections

17. Burn injuries from hot liquids causing tissue necrosis

18. Infections causing tissue breakdown (e.g., necrotizing fasciitis)

19. Autoimmune conditions (e.g., scleroderma) weakening muscle

20. Degenerative age-related changes reducing elasticity Cleveland ClinicFrontiers

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Symptoms

Symptoms vary by grade but may include:

1. Sharp tongue pain at injury site Cleveland Clinic

2. Tenderness on palpation

3. Swelling or bulge on tongue underside

4. Bruising or submucosal hematoma

5. Bleeding from mucosal tears

6. Visible gap or indentation in tongue contour

7. Difficulty moving tongue side-to-side

8. Impaired tip depression

9. Altered speech (slurred, lisping)

10. Difficulty swallowing (dysphagia)

11. Excessive drooling

12. Burning sensation on movement

13. Muscle weakness when trying to retract

14. “Pop” sound at moment of injury Cleveland Clinic

15. Reduced tongue protrusion

16. Ulceration if mucosa also torn

17. Numbness if nerve irritation occurs

18. Fever if secondary infection develops

19. Inability to form central groove

20. Speech articulation errors (e.g., inability to roll “r”) WebMD

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Diagnostic Tests

1. Physical exam: inspection, palpation, strength testing Cleveland Clinic

2. Ultrasonography (intraoral): visualizes fiber disruption without radiation PMC

3. MRI: gold standard for soft tissue tear extent and grading Cleveland Clinic

4. CT scan: if bone involvement suspected

5. X-ray: plain films to rule out foreign bodies

6. Flexible endoscopic evaluation: assess mucosal injury

7. Electromyography (EMG): evaluates muscle electrical activity Home

8. Nerve conduction study (NCS): rules out neuropathy

9. Shear-wave elastography: quantifies muscle stiffness Wikipedia

10. Ultrasound elastography: assesses tissue elasticity Frontiers

11. Biopsy: if underlying myositis or tumor

12. Blood tests: creatine kinase (CK) levels for muscle damage

13. Complete blood count (CBC): checks for infection

14. C-reactive protein (CRP): inflammation marker

15. Electrolyte panel: rules out metabolic causes

16. Speech/swallowing evaluation: functional assessment

17. Dynamic MRI: real-time movement analysis

18. Video fluoroscopic swallow study: assesses dysphagia

19. Ultrasound Doppler: evaluates blood flow to injured area

20. Genetic testing: in suspected muscular dystrophy cases

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Non-Pharmacological Treatments

1. Rest: avoid tongue strain for 48–72 hours Cleveland Clinic

2. Ice application: reduce swelling (10 min on/off)

3. Compression dressings: gentle tongue wrap with gauze

4. Elevation: keep head upright to limit edema

5. Warm compresses: after first 48 h to improve circulation

6. Speech therapy: guided exercises for safe speech

7. Swallowing therapy: improve dysphagia techniques

8. Isometric tongue exercises: gentle holds against resistance

9. Myofascial release: manual soft-tissue mobilization

10. Ultrasound therapy: therapeutic ultrasound for healing

11. Electrical stimulation (TENS): pain modulation

12. Laser therapy (LLLT): accelerates tissue repair

13. Acupuncture: adjunct pain relief

14. Dry needling: targets myofascial trigger points

15. Kinesio taping: supports tongue muscles

16. Biofeedback: visual feedback during exercises

17. Hydrotherapy: warm water exercises for tongue mobility

18. Diet modification: soft, cool foods to avoid irritation

19. Hydration: adequate fluids for tissue viability

20. Ultrasound-guided collagen injections: experimental support

21. Low-level laser acupuncture: combines LLLT and acupuncture

22. Massage: gentle intraoral massage around tear area

23. Oral motor training: strengthen damaged fibers gradually

24. Proprioceptive neuromuscular facilitation: advanced rehab

25. Yoga and meditation: reduce pain perception

26. Ergonomic posture training: optimize head/neck position

27. Mouth guards: prevent re-injury during sports

28. Soft splints: protect tongue at night

29. Cervical collar: if neck position exacerbates pain

30. Psychological support: coping strategies for chronic pain

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Drugs

1. Ibuprofen (NSAID) for pain and inflammation Cleveland Clinic

2. Naproxen (NSAID)

3. Aspirin

4. Acetaminophen (analgesic)

5. Diclofenac gel (topical NSAID)

6. Lidocaine viscous (topical anesthetic)

7. Benzocaine spray (oral topical)

8. Ketorolac (short-term injectable NSAID)

9. Prednisone (oral steroid) for severe inflammation

10. Methylprednisolone (steroid)

11. Cyclobenzaprine (muscle relaxant)

12. Tizanidine (muscle relaxant)

13. Gabapentin (neuropathic pain)

14. Amitriptyline (tricyclic for neuropathic pain)

15. Clonazepam (for muscle spasms)

16. Dantrolene (spasmolytic)

17. Botulinum toxin A (off-label for refractory spasm)

18. Antibiotic mouth rinse (e.g., chlorhexidine) if risk of infection

19. Antifungal agents (for secondary candidiasis)

20. Analgesic lozenges (e.g., benzocaine/hydrocortisone)

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Surgical Treatments

1. Primary suture repair of muscle fibers for grade III tears My Health Alberta

2. Layered closure: mucosa plus muscle repair

3. Local flap reconstruction for tissue loss

4. Free tissue grafts (e.g., tongue flap)

5. Microvascular free flap for extensive defects

6. Frenuloplasty if concurrent frenulum tear

7. Debridement of necrotic tissue

8. Platelet-rich plasma injection during surgery

9. Nerve repair if hypoglossal branch severed

10. Secondary scar revision for functional restoration

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Prevention Strategies

1. Use mouthguards during contact sports Cleveland Clinic

2. Soft diet during illness or dental healing

3. Regular dental check-ups to smooth sharp teeth

4. Avoid oral piercings or remove jewelery when active

5. Proper intubation techniques in healthcare settings

6. Gradual stretching exercises before extreme tongue use

7. Maintain good oral hygiene to prevent ulcers

8. Hydrate well to keep mucosa supple

9. Ergonomic head and neck posture

10. Warm-up exercises for orofacial muscles before public speaking

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When to See a Doctor

Seek prompt medical attention if you experience:

• Severe bleeding that doesn’t stop after 15 minutes.

• “Pop” sensation with instant loss of tongue movement.

• Inability to speak or swallow normally.

• Signs of infection: fever, spreading redness, increasing pain.

• Persistent symptoms beyond 3 days of home care.

• Nerve symptoms: numbness, tingling, facial weakness.

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Frequently Asked Questions