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Superior Longitudinal Muscle Cysts

Dr. Marianne Abouyared, Md - Otolaryngology (ENT) Dr. Marianne Abouyared, Md - Otolaryngology (ENT)
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Rx Musculoskeletal System (A - Z)

Cysts affecting the superior longitudinal muscle of the tongue are uncommon lesions that arise when fluid-filled sacs develop within or immediately adjacent to the intrinsic musculature of the tongue’s dorsal surface. These cysts can interfere with the normal shape and function of the tongue, leading to difficulties in speaking, swallowing, and maintaining oral hygiene. An understanding of their anatomy, types, causes, symptoms, diagnostics, treatments, and prevention is essential for prompt recognition and management.

Anatomy of the Superior Longitudinal Muscle

The superior longitudinal muscle is one of four intrinsic muscles of the tongue, lying immediately beneath the mucosa on the dorsal surface. Its fibers run longitudinally from the base to the tip of the tongue and fan out toward the lateral margins. NCBIRadiopaedia

  • Structure & Location: A thin but centrally thick band of oblique and longitudinal fibers directly under the dorsal mucosa of the tongue. Wikipedia

  • Origin: Submucous fibrous layer near the epiglottis and the median fibrous septum. Wikipedia

  • Insertion: Apex and lateral margins of the tongue, blending with the mucous membrane. Kenhub

  • Blood Supply: Primarily from the sublingual branch of the lingual artery, with contributions from the deep lingual arteries. NCBI

  • Nerve Supply: Motor innervation via the hypoglossal nerve (cranial nerve XII). Radiopaedia

  • Functions (6):

    1. Shortens the tongue, making it broader. NCBI

    2. Curls the tip and sides upward (dorsiflexion). NCBI

    3. Aids in retracting the protruded tongue. Radiopaedia

    4. Contributes to shaping the tongue during speech articulation. TeachMeAnatomy

    5. Aids in manipulating food during mastication. TeachMeAnatomy

    6. Assists in swallowing by helping to push the bolus posteriorly. TeachMeAnatomy

Types of Tongue Cysts Involving the Superior Longitudinal Muscle

  1. Mucocele (Mucous Extravasation Cyst): A benign cyst caused by mucus pooling from a ruptured minor salivary gland duct; appears as a bluish, fluctuant swelling. NCBI

  2. Ranula: A mucocele of the floor of the mouth arising from major salivary gland obstruction; can extend into the neck (plunging ranula). Radiopaedia

  3. Epidermoid Cyst: A developmental ectodermal inclusion cyst lined by keratinizing squamous epithelium, usually painless. ScienceDirect

  4. Dermoid Cyst: A midline cyst containing skin appendages (hair follicles, sebaceous glands), arising from trapped ectodermal tissue. MDPI

  5. Lymphoepithelial Cyst: A small cyst with lymphoid aggregates in its wall, often found on the ventral tongue. PMC

  6. Thyroglossal Duct Cyst: A midline cystic remnant of the thyroglossal duct, sometimes presenting near the tongue base. PMC

  7. Foregut Duplication Cyst: Rare congenital cyst lined by respiratory or gastrointestinal epithelium, representing foregut remnants. ScienceDirect

  8. Cysticercosis Cyst: Parasitic cysts of Taenia solium can rarely involve tongue muscles, causing nodular lesions. SAGE Journals

Causes

  1. Minor Trauma to Tongue Mucosa: Repeated biting or impact leading to duct rupture and mucocele formation. NCBI

  2. Salivary Duct Obstruction: Blockage from sialoliths or scarring causing retention cysts. NCBI

  3. Developmental Ectodermal Inclusion: Embryonic trapping of epithelial cells leading to epidermoid/dermoid cysts. MDPI

  4. Persistence of Thyroglossal Duct: Failure of duct to involute, creating midline cysts. PMC

  5. Foregut Remnants: Misplaced respiratory or gastrointestinal epithelium forming duplication cysts. ScienceDirect

  6. Parasitic Infection: Cysticercus larvae lodging in muscle tissue. SAGE Journals

  7. Lymphoid Tissue Entrapment: Formation of lymphoepithelial cysts within lymphoid aggregates. PMC

  8. Post‑surgical Scarring: Fibrosis from prior tongue surgery blocking salivary flow. NCBI

  9. Radiation Therapy: Fibrosis of minor salivary glands leading to retention cysts. NCBI

  10. Infectious Inflammation: Chronic infection causing ductal damage and cyst development. NCBI

  11. Sjӧgren’s Syndrome: Autoimmune destruction of glands causing retention phenomena. NCBI

  12. Mucous Gland Hypoplasia: Congenital underdevelopment leading to cystic dilatation. NCBI

  13. Genetic Syndromes: E.g., Gardner syndrome with epidermoid cyst tendency. MDPI

  14. Mechanical Compression: Pressure from nearby tumors or prostheses obstructing ducts. NCBI

  15. Allergic Edema: Repeated angioedema episodes leading to duct damage. NCBI

  16. Chemical Irritation: Tobacco or caustic agents damaging ducts. NCBI

  17. Nutritional Deficiencies: Vitamin A deficiency affecting epithelial turnover. NCBI

  18. Hormonal Changes: Pregnancy-associated gland enlargement causing retention. NCBI

  19. Connective Tissue Disorders: Scleroderma causing fibrosis of duct walls. NCBI

  20. Idiopathic: No identifiable cause.

Symptoms

  1. Painless swelling on the tongue’s surface.

  2. Bluish or translucent dome-shaped lesion.

  3. Fluctuant consistency upon palpation.

  4. Difficulty articulating certain sounds.

  5. Interference with mastication or chewing.

  6. Sensation of a lump (“globus”) in the mouth.

  7. Occasional pain when secondarily infected.

  8. Ulceration or bleeding if traumatized.

  9. Intermittent size fluctuation.

  10. Thick saliva or drooling.

  11. Difficulty swallowing (dysphagia).

  12. Altered taste sensation.

  13. Speech impediments (lisping).

  14. Tongue deviation on protrusion if large.

  15. Pressure sensation on the floor of mouth.

  16. Airway obstruction in massive lesions.

  17. Expansile neck swelling (plunging ranula).

  18. Redness or warmth (infection).

  19. Fever if abscessed.

  20. Recurrent rupture with rapid refilling.

Diagnostic Tests

  1. Clinical Examination: Inspection and palpation of the lesion.

  2. Transillumination Test: Cyst lights up under strong light.

  3. Ultrasound (US): Differentiates cystic vs. solid lesions.

  4. Magnetic Resonance Imaging (MRI): Defines extent and relation to muscles.

  5. Computed Tomography (CT): Visualizes calcifications and deep spread.

  6. Fine‑Needle Aspiration Cytology (FNAC): Analyzes cyst content.

  7. Histopathology: Examines excised tissue post‑surgery.

  8. Sialography: Outlines salivary ducts (for ranula).

  9. High‑Frequency US: Detailed imaging of tongue musculature.

  10. Endoscopic Evaluation: Uses small camera to assess mucosal involvement.

  11. Doppler US: Excludes vascular malformations.

  12. Complete Blood Count (CBC): Detects infection.

  13. C‑Reactive Protein (CRP)/ESR: Inflammation markers.

  14. Thyroid Function Tests: Rule out thyroglossal duct cyst.

  15. Serology for Parasitic Infections: E.g., cysticercosis.

  16. Allergy Testing: If angioedema suspected.

  17. Genetic Testing: For syndromic associations.

  18. Biopsy of Cyst Wall: Confirms epithelial lining type.

  19. Panoramic X‑ray: Rules out mandibular involvement.

  20. Electromyography (EMG): Rarely, to assess muscle function if involved.

Non‑Pharmacological Treatments

  1. Watchful Waiting: Small, asymptomatic cysts may regress.

  2. Needle Aspiration: Temporary relief by draining fluid.

  3. Cryotherapy: Freezing cyst walls to induce involution.

  4. Laser Ablation: CO₂ laser to vaporize lining.

  5. Marsupialization: Creating a permanent opening to prevent refilling.

  6. Microsurgical Excision: Precise removal with minimal trauma.

  7. Electrocautery: Burning cyst lining to prevent recurrence.

  8. Ultrasound‑Guided Aspiration: Real‑time drainage.

  9. Endoscopic Fenestration: Minimally invasive opening.

  10. Cryoextraction: Combined freezing and removal.

  11. Sclerotherapy with Physical Agents: E.g., ethanol-free mechanical sclerosis.

  12. Tongue Massage Exercises: Improves circulation, may aid resolution.

  13. Warm Compresses: Promotes drainage in mucoceles.

  14. Laser‑Assisted Vaporization: Reduces lesion bulk.

  15. Carbon Dioxide Snow: Localized tissue freezing.

  16. Diode Laser Excision: Precise cutting with hemostasis.

  17. Microdebrider Removal: Shaves cyst lining.

  18. Endoscopic‑Assisted Resection: Enhanced visualization.

  19. Marsupialization with Sterile Stent: Keeps opening patent.

  20. Tongue‑Stent Therapy: Applies gentle pressure to prevent re‑accumulation.

  21. Low‑Level Laser Therapy (LLLT): Promotes healing.

  22. Photodynamic Therapy: Uses light‑activated agents.

  23. Manual Compression Techniques: To express fluid.

  24. Acupuncture: Unproven but used in some traditions.

  25. Laser‑Guided Biopsy and Excision: Diagnostic and therapeutic.

  26. Hydrodissection‑Assisted Removal: Fluid separation of cyst from tissue.

  27. Transmucosal Stenting: Long‑term drainage pathway.

  28. Cryosurgical Probe Application: Controlled freezing.

  29. Endoscopic Sclerotherapy with Physical Probes: Mechanical disruption.

  30. Oral Physiotherapy: Enhances tongue mobility post‑treatment.

Drugs

  1. Triamcinolone Injection: Reduces inflammation in retention cysts.

  2. Doxycycline Sclerotherapy: Sclerosing agent for cyst closure.

  3. Picibanil (OK‑432): Immunomodulator for lymphangiomatous cysts.

  4. Methylprednisolone: Systemic steroid for angioedema‑related cystic swelling.

  5. Amoxicillin‑Clavulanate: Empiric antibiotic if secondarily infected.

  6. Clindamycin: For penicillin‑allergic patients.

  7. Metronidazole: Covers anaerobic oral flora.

  8. Cephalexin: First‑line oral antibiotic.

  9. Ibuprofen: Nonsteroidal anti‑inflammatory for pain relief.

  10. Acetaminophen: Analgesic.

  11. Diclofenac Gel: Topical NSAID for surface lesions.

  12. Lidocaine Ointment: Topical anesthetic for symptomatic relief.

  13. Benzocaine Spray: Surface anesthesia during procedures.

  14. Hydrocortisone Cream: Reduces local inflammation.

  15. Tetracycline Rinse: Adjunctive antiseptic.

  16. Chlorhexidine Mouthwash: Prevents secondary infection.

  17. Kenalog‑in‑Orabase: Long‑acting topical steroid.

  18. Ethanol Injection (Low Concentration): Sclerosing agent.

  19. Bleomycin: Sclerotherapy for lymphatic malformations.

  20. Propranolol: Off‑label for vascular cystic lesions.

Surgical Options

  1. Excisional Biopsy: Complete removal with histopathology.

  2. Marsupialization of Ranula: Simple floor‑of‑mouth drainage.

  3. Sublingual Gland Excision: To prevent ranula recurrence.

  4. Plunging Ranula Repair: Trans‑cervical approach to remove cyst.

  5. Laser Excision: CO₂ laser for precision and hemostasis.

  6. Cryosurgery: Controlled freezing in an operating room.

  7. Dermoid Cyst Enucleation: Complete removal of cyst wall.

  8. Thyroglossal Duct Cyst Excision (Sistrunk Procedure): Includes tract removal.

  9. Foregut Duplication Cyst Resection: Via transoral or transcervical route.

  10. Tongue Flap Reconstruction: For large defects after excision.

Preventive Measures

  1. Avoid Tongue Trauma: Be cautious when eating hard or sharp foods.

  2. Maintain Oral Hygiene: Regular brushing and flossing.

  3. Prompt Treatment of Infections: Early antibiotic therapy.

  4. Protective Dental Guards: If prone to tongue biting.

  5. Regular Dental Check‑ups: Early detection of duct obstruction.

  6. Avoid Tobacco & Alcohol: Reduce mucosal irritation.

  7. Hydration: Keeps salivary flow normal.

  8. Manage Systemic Diseases: Control diabetes and autoimmune disorders.

  9. Prenatal Screening for Syndromes: Identifies congenital predispositions.

  10. Educate on Proper Oral Habits: Discourage lip/tongue biting.

When to See a Doctor

Seek professional evaluation if you notice any of the following—especially if present for over two weeks or worsening:

  • A persistent lump or swelling on your tongue.

  • Pain, ulceration, or bleeding in the lesion.

  • Difficulty speaking, chewing, or swallowing.

  • Rapid growth or fluctuation in size.

  • Signs of infection: redness, warmth, fever.

  • Airway obstruction symptoms, such as breathing difficulty.

Prompt diagnosis can prevent complications and expedite appropriate treatment.

Frequently Asked Questions

  1. What exactly is a tongue cyst?
    A tongue cyst is a fluid‑filled sac that forms in or near the tongue’s muscles or glands, often due to blocked ducts or developmental remnants.

  2. Are tongue cysts cancerous?
    No, most tongue cysts (e.g., mucoceles, ranulas, dermoid cysts) are benign and non‑cancerous.

  3. Can a tongue cyst go away on its own?
    Small mucoceles may spontaneously regress, but most require drainage or removal to prevent recurrence.

  4. How is a tongue cyst diagnosed?
    Diagnosis typically involves clinical examination, imaging (ultrasound or MRI), and sometimes needle aspiration or biopsy.

  5. Is needle aspiration enough to treat a cyst?
    Aspiration can provide temporary relief but often leads to recurrence without definitive treatment like excision or marsupialization.

  6. What are the risks of surgically removing a tongue cyst?
    Risks include bleeding, infection, temporary tongue mobility impairment, and scar formation.

  7. Will the cyst come back after treatment?
    Recurrence rates vary: marsupialization and gland excision have lower recurrence for ranulas, while simple aspiration has higher rates.

  8. Is general anesthesia required?
    Small cysts may be excised under local anesthesia; larger or deeper lesions may require general anesthesia.

  9. How long is recovery after cyst removal?
    Most patients resume normal activity within 1–2 days; complete healing may take 1–2 weeks.

  10. Can children get tongue cysts?
    Yes—mucoceles and ranulas are particularly common in children and adolescents.

  11. Do cysts affect speech permanently?
    Temporary speech changes can occur, but full recovery of articulation is expected once the cyst is removed.

  12. Are there non‑surgical treatment options?
    Yes: needle aspiration, cryotherapy, laser ablation, or watchful waiting for very small lesions.

  13. Will I need antibiotics after surgery?
    Antibiotics are often prescribed for surgical or infected cysts to prevent secondary infection.

  14. Can diet influence cyst formation?
    Spicy, acidic, or hot foods may irritate cysts but don’t directly cause them.

  15. When should I be worried about complications?
    Seek urgent care if you experience severe pain, rapid swelling, difficulty breathing, or high fever.

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.

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References

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