Superior Longitudinal Muscle Tears

A superior longitudinal muscle tear is an injury in which the intrinsic muscle fibers just beneath the dorsal mucosa of the tongue are overstretched or torn. Unlike tears of larger skeletal muscles, these injuries affect the shape‑changing fibers that run from the tongue’s median septum to its lateral margins. Tears can range from microscopic fiber splits to full‑thickness ruptures, often resulting from direct trauma, accidental bites, or iatrogenic injuries during procedures such as intubation. Because the tongue has an exceptionally rich blood supply and rapid healing potential, small tears may close on their own, while deeper or larger tears often require layered suturing and rest to restore normal function and prevent complications like hematoma formation or infection PMCMedscape.

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Anatomy of the Superior Longitudinal Muscle

Structure and Location

The superior longitudinal muscle lies immediately under the mucous membrane on the dorsum (top) of the tongue. It spans the entire length of the tongue, from the base (near the hyoid region) to the tip, forming a thin sheet of fibers on both the right and left sides of the midline septum. This submucosal position makes it vital for fine reshaping of the tongue during speech, swallowing, and eating KenhubNCBI.

Origin and Insertion

• Origin: Fibers originate in the fibrous median lingual septum and the submucosa of the posterior tongue.

• Insertion: They insert onto the anterolateral margins and tip (apex) of the tongue.
  This arrangement enables the muscle to pull the tongue’s tip backward and upward when it contracts Kenhubwww.elsevier.com.

Blood Supply and Nerve Supply

• Blood Supply: Branches of the lingual artery (a direct branch of the external carotid artery) and its sublingual branches provide oxygen and nutrients Kenhub.

• Nerve Supply: The hypoglossal nerve (cranial nerve XII) innervates all intrinsic tongue muscles except palatoglossus, allowing precise motor control for shape changes Kenhub.

Functions

The superior longitudinal muscle contributes to six key actions of the tongue:

1. Shortening the tongue body, making it thicker.

2. Elevating the tongue tip toward the palate (dorsiflexion).

3. Retracting the tongue from a protruded position.

4. Broadening the tongue by pulling the sides inward.

5. Curling the edges of the tongue upward for grooving.

6. Fine shape adjustments needed for articulation and manipulating food in the mouth NCBI.

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Types of Tears

1. By Severity (Grading System)
Muscle tears are commonly graded based on fiber disruption and functional loss:

• Grade I (Mild): Microscopic tears or overstretching of fibers with minimal pain and no significant loss of function.

• Grade II (Moderate): Partial muscle fiber disruption leading to moderate pain, swelling, and measurable loss of strength or range of motion.

• Grade III (Severe): Complete rupture of the muscle resulting in intense pain, a palpable gap, bruising, and near‑total loss of function Hospital for Special SurgeryRadiopaedia.

2. By Location of the Tear
Clinicians also classify tongue tears by where on the tongue they occur:

• Anterior Dorsum: The most common site, near the tip, from accidental bites or lacerations.

• Lateral Border: Often from sharp objects or during seizures when the tongue contacts teeth.

• Median Dorsum: Less common; typically from penetrating injuries.

• Posterior Region: Rare due to deep location; associated with severe blunt trauma or surgical mishaps PMC.

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Causes of Superior Longitudinal Muscle Tears

1. Accidental tongue biting during chewing or seizures

2. Sports injuries (e.g., contact sports without mouthguard)

3. Motor vehicle accidents with oral trauma

4. Falls resulting in blunt force to the mouth

5. Surgical lacerations during tonsillectomy or intubation MedscapePMC

6. Dental instrumentation (e.g., drills, scalers)

7. Oral piercings causing direct muscle trauma

8. Alcohol‑related falls leading to face impact

9. Assaults involving punches or blows to the jaw

10. Sharp object injuries (e.g., knives, glass)

11. Thermal burns that weaken muscle fibers

12. Chemical burns from caustic ingestion

13. Radiation therapy causing mucosal and muscle fragility

14. Seizure‑related tongue trauma during uncontrolled jaw movements

15. Whiplash‑associated hyperextension causing indirect stretch injuries

16. Iatrogenic trauma during dental extractions

17. Ballistic injuries from gunshot wounds

18. Self‑inflicted wounds in psychiatric conditions

19. Congenital connective tissue disorders leading to fragile muscle

20. Repeated micro‑trauma from ill‑fitting dentures

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Symptoms of Superior Longitudinal Muscle Tears

1. Sharp pain at the site of injury

2. Swelling of the tongue tip or dorsum

3. Bleeding or hematoma formation

4. Bruising (ecchymosis) under the tongue mucosa

5. Difficulty protruding or retracting the tongue

6. Limited tongue movement during speech

7. Slurred speech (dysarthria)

8. Difficulty chewing or manipulating food

9. Pain when swallowing (odynophagia)

10. Altered taste or numbness

11. Tongue deviation toward the injured side

12. Visible tear or laceration on inspection

13. Fever if infection develops

14. Pus discharge from deep tears

15. Increased salivation or drooling

16. Difficulty maintaining hygiene, leading to bad breath

17. Muscle spasm around the tear site

18. Fatigue of tongue muscles

19. Dry mouth if function is severely limited

20. Speech fatigue after prolonged talking MedscapeRadiopaedia

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Diagnostic Tests

1. Clinical oral examination with good lighting

2. Palpation to detect gaps or muscle defects

3. Visual inspection for lacerations or hematoma

4. Ultrasound imaging for tear depth and extent

5. Magnetic Resonance Imaging (MRI) for detailed soft‑tissue view

6. Computed Tomography (CT) if bone injury is suspected

7. Fiberoptic endoscopic examination for posterior tears

8. Speech evaluation by a speech‑language pathologist

9. Swallow study (videofluoroscopic) for dysphagia

10. Electromyography (EMG) for muscle activity assessment

11. Nerve conduction studies if hypoglossal nerve injury is suspected

12. Tongue range‑of‑motion measurements

13. Pain scale assessment (e.g., Visual Analog Scale)

14. Photographic documentation for tracking healing

15. Ultrasound elastography for tissue stiffness

16. Blood tests if systemic infection is suspected

17. Culture of any discharge to guide antibiotics

18. Salivary flow measurement if dry mouth is reported

19. Biopsy of chronic non‑healing tears (rare)

20. Functional MRI in research settings to study compensatory activity RSNA PublicationsMedscape

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Non‑Pharmacological Treatments

1. Rest: Limit tongue movement for 3–5 days

2. Ice packs applied externally to reduce swelling

3. Compression dressings using gauze inside the mouth

4. Layered suturing of deeper tears PMCHospital for Special Surgery

5. Speech therapy for articulation exercises

6. Myofunctional therapy to retrain intrinsic muscles

7. Gentle tongue stretches once acute pain subsides

8. Ultrasound therapy to promote healing

9. Low‑level laser therapy (LLLT) for pain relief

10. Electrical stimulation to maintain muscle tone

11. Hyperbaric oxygen therapy in selected cases

12. Photobiomodulation to accelerate tissue repair

13. Manual massage of perilingual tissues

14. Nutritional support with soft, high‑protein diet

15. Hydration therapy to maintain moisture

16. Chlorhexidine mouthwash for hygiene

17. Saline rinses to keep the wound clean

18. Use of mouth guard during sleep to avoid bites

19. Cold diet (e.g., ice‑cream, smoothies) initially

20. Progressive resistance exercises under guidance

21. Thermal therapy (warm compresses) after 48 hours

22. Proprioceptive training with tongue placement tasks

23. Biofeedback to monitor tongue movement

24. Orthotic tongue splints in severe cases

25. Acupuncture for pain modulation

26. Relaxation techniques to reduce muscle spasm

27. Laser‑assisted tissue regeneration

28. Platelet‑rich plasma (PRP) injection experimental

29. Avoidance of irritants (spicy foods, alcohol)

30. Regular follow‑up with imaging to track healing Hospital for Special SurgeryPMC

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Pharmacological Treatments

1. Ibuprofen (NSAID) for pain and inflammation

2. Paracetamol (acetaminophen) for mild pain

3. Diclofenac sodium tablets or gel

4. Ketorolac for short‑term severe pain

5. Topical lidocaine gel swish and spit

6. Benzocaine lozenges for surface anesthesia

7. Corticosteroid mouthwash (e.g., dexamethasone)

8. Amoxicillin prophylaxis in deep tears

9. Clindamycin if penicillin allergy

10. Metronidazole for anaerobic coverage

11. Chlorhexidine gluconate mouth rinse

12. Vitamin C supplements to support collagen repair

13. Vitamin B complex for nerve health

14. Analgesic‑antacid combinations to protect gastric mucosa

15. Tranexamic acid mouthwash for bleeding control

16. Systemic corticosteroids in severe edema

17. Antifibrinolytics in bleeding disorders

18. Antibiotic lozenges for localized infection

19. Sucralfate suspension to coat the wound

20. Topical NSAID spray for direct application MedscapePMC

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Surgical Options

1. Primary layered closure under local or general anesthesia PMCDove Press

2. Debridement and trimmed closure of ragged edges

3. Local mucosal flap to cover large defects

4. Buccinator myomucosal flap for lateral border tears

5. Free radial forearm flap in extensive tissue loss

6. Microvascular free flap reconstruction for complex avulsions

7. Pedicled tongue flap for midline defects

8. Platelet‑rich fibrin membrane placement

9. Laser excision and coagulation for clean margins

10. Arterial and venous anastomosis in complete amputations PMCDove Press

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 Preventive Measures

1. Wear a mouth guard during sports MedscapePMC

2. Use protective gear in high‑risk activities

3. Avoid oral piercings that may injure the tongue

4. Practice safe intubation techniques in clinical settings

5. Maintain good dental hygiene to prevent accidental bites

6. Ensure dentures fit properly to avoid abrasion

7. Limit alcohol consumption to reduce fall risk

8. Educate seizure patients on tongue protection devices

9. Avoid chewing hard objects (ice, pens)

10. Regular dental checkups to identify sharp edges

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When to See a Doctor

Seek medical attention if you experience:

• Persistent bleeding that soaks through gauze after 30–60 minutes

• Severe pain not relieved by over‑the‑counter analgesics

• Visible gap in tongue muscle or a flap of tissue

• Signs of infection (fever, pus, foul odor)

• Difficulty breathing or maintaining an open airway

• Inability to move the tongue normally after 48 hours

• Numbness or altered sensation beyond 24 hours PMCMedscape

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Frequently Asked Questions

1. What is a superior longitudinal muscle tear?
A tear in this muscle means some of the tiny fibers under the top surface of the tongue have been stretched or split. It affects how the tongue changes shape for speech and swallowing MedscapeNCBI.

2. How do these tears happen?
Most tears occur from accidental bites, falls, sports injuries, or medical procedures like intubation. Even small impacts can damage these shallow muscle fibers MedscapePMC.

3. What symptoms should I watch for?
Key signs include sharp pain on the tongue, swelling, bleeding, and difficulty moving the tip up or down. You might also notice bruising under the mucosa and trouble speaking clearly RadiopaediaMedscape.

4. How is a tear diagnosed?
Your doctor will examine the inside of your mouth, feel for gaps, and may use ultrasound or MRI to see how deep the tear goes. Sometimes, a swallow study or EMG is needed for larger injuries RSNA PublicationsMedscape.

5. Can small tears heal on their own?
Yes. Minor (Grade I) tears often close naturally because the tongue has good blood flow. Rest, ice, and soft diet are usually enough for these mild injuries Hospital for Special SurgeryPMC.

6. When is surgery needed?
Surgery is needed for deeper (Grade II) or complete tears (Grade III), especially if there’s heavy bleeding or a visible gap. Layered suturing helps align the muscle fibers so they heal with minimal scar tissue PMCDove Press.

7. How long does recovery take?
Mild tears may heal in 1–2 weeks. More severe tears can take 4–6 weeks or longer, especially if physical therapy is needed to restore full motion PMCMedscape.

8. Will I regain full function?
With proper care, most people recover full shape‑changing ability and regain normal speech and swallowing. However, large or delayed‑treated tears may leave minor deficits in precision movements PMCNCBI.

9. Can I eat and drink normally during healing?
You’ll start with soft, cool foods like yogurt or smoothies. Gradually return to a normal diet as pain subsides. Avoid hot, spicy, or hard foods for at least a week Hospital for Special SurgeryPMC.

10. What exercises help my recovery?
Gentle tongue stretches and shape‑making exercises guided by a speech therapist strengthen the muscle and prevent stiffness. Myofunctional therapy can speed up full recovery Hospital for Special SurgeryPMC.

11. Is there a risk of infection?
Yes. Deep tears can trap bacteria, leading to infection. Rinsing with saline or chlorhexidine and taking prescribed antibiotics help prevent this complication PMCMedscape.

12. Can tears affect my sense of taste?
Taste buds lie close to these fibers. Temporary altered taste or numbness can occur but usually resolves as healing progresses MedscapePMC.

13. What if I accidentally bite my tongue again?
Use a mouth guard or orthodontic plate to protect the tongue. Rest the injured area and apply ice immediately to reduce swelling MedscapePMC.

14. Are there long‑term complications?
Scar tissue can slightly limit fine tongue movements, but this is uncommon with timely repair. Large untreated tears risk chronic pain or persistent deformity PMCNCBI.

15. How can I prevent future tears?
Wear protective gear in sports, avoid oral piercings, practice safe swallowing of sharp foods, and ensure medical and dental professionals use gentle techniques near your tongue MedscapePMC.

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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