Tongue Extrinsic Muscle Cysts

Cysts of the extrinsic tongue muscles are fluid‑filled sacs or pseudocavities that develop within or adjacent to the muscles which originate outside the tongue and insert into it. These cysts arise when salivary mucus, epithelial remnants, or other tissue elements become trapped and form a sac-like lesion, leading to swelling, discomfort, or functional impairment of tongue movement RadiopaediaVerywell Health.

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Anatomy of Extrinsic Tongue Muscles

Extrinsic tongue muscles originate on bony or soft‑tissue structures outside the tongue and insert into its body, anchoring and moving it within the oral cavity. There are four key extrinsic muscles:

• Genioglossus: Originates from the superior genial tubercle (mental spine) of the mandible and inserts along the inferior tongue surface and body of the hyoid bone.

• Hyoglossus: Arises from the body and greater horn of the hyoid bone and inserts into the lateral tongue.

• Styloglossus: Begins at the anterolateral styloid process of the temporal bone and stylomandibular ligament, inserting into the lateral tongue musculature.

• Palatoglossus: Originates from the palatine aponeurosis of the soft palate and inserts into the lateral margins of the tongue.

Blood supply to these muscles is primarily via the lingual artery (a branch of the external carotid) and its dorsal, deep, and sublingual branches. Venous drainage follows the lingual veins into the internal jugular vein. Motor innervation is by the hypoglossal nerve (CN XII) for all except palatoglossus, which is served by the vagus nerve (CN X) via the pharyngeal plexus TeachMeAnatomyKenhub.

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Functions of Extrinsic Tongue Muscles

Collectively, the extrinsic muscles enable the tongue’s gross movements essential for speech, swallowing, and airway maintenance. Six principal actions include:

1. Protrusion (genioglossus) – sticks the tongue out of the mouth.

2. Retraction (styloglossus) – pulls the tongue back into the mouth.

3. Depression (hyoglossus and inferior genioglossus fibers) – lowers the tongue from its resting position.

4. Elevation (palatoglossus and superior styloglossus fibers) – raises the posterior tongue.

5. Lateral Deviation (unilateral contraction of genioglossus) – moves the tongue side to side.

6. Oropharyngeal Isthmus Constriction (palatoglossus) – narrows the opening between the oral cavity and pharynx. Geeky MedicsKenhub.

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Types of Tongue Extrinsic Muscle Cysts

1. Ranula

   • A mucus extravasation pseudocyst arising from the sublingual gland that can remain above (simple ranula) or plunge below the mylohyoid into the neck (plunging ranula). RadiopaediaOptecoto

2. Dermoid (True) Cyst

   • A developmental cyst lined by squamous epithelium with skin appendages (hair follicles, sebaceous glands) often presenting as a midline floor‑of‑mouth mass. RadiopaediaMDPI

3. Epidermoid Cyst

   • A keratin‑filled cyst lined by stratified squamous epithelium without adnexal structures; part of the dermoid spectrum but lacking skin appendages. IU Indianapolis ScholarWorksCambridge University Press & Assessment

4. Oral Lymphoepithelial Cyst

   • A rare developmental lesion characterized by a stratified squamous‑lined lumen with lymphoid tissue in the capsule, typically on the lateral tongue or floor of the mouth. PathologyOutlines.comSciELO

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Common Causes

Cysts of extrinsic tongue muscles form due to a variety of triggers:

1. Trauma (tongue biting, dental procedures)

2. Salivary Duct Obstruction (sialolithiasis)

3. Congenital Epithelial Remnants (branchial or thyroglossal duct remnants)

4. Chronic Inflammation (sialadenitis)

5. Infection (viral: Coxsackie, bacterial)

6. Iatrogenic Injury (oral surgery)

7. Tissue Entrapment During Embryogenesis

8. Genetic Predisposition (syndromic associations)

9. Autoimmune Disorders (e.g., Sjögren’s syndrome)

10. Metabolic Conditions (diabetes mellitus)

11. Allergic Reactions (to foods or medications)

12. Radiation Exposure (head and neck radiotherapy)

13. Habitual Tongue Friction (orthodontic appliances)

14. Salivary Gland Tumors (adjacent ductal obstruction)

15. Nutritional Deficiencies (vitamin A, zinc)

16. Environmental Toxins (tobacco, alcohol)

17. Hormonal Changes (pregnancy, puberty)

18. Parasitic Infestation (rare)

19. Foreign Body Reaction (embedded particles)

20. Idiopathic (unknown)

These factors can lead to mucus retention, epithelial proliferation, or ductal rupture, culminating in cyst formation Verywell HealthMedscape.

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Key Symptoms

Patients often present with:

• A painless, bluish or translucent swelling under the tongue

• Fluctuant (compressible) mass in floor of mouth

• Dysphagia (difficulty swallowing)

• Dysarthria (speech impairment)

• Glossalgia (tongue pain) when infected

• Drooling or pooling of saliva

• Sensation of fullness in mouth

• Altered taste sensation

• Tongue displacement or deviation

• Snoring or sleep‑disordered breathing (if large)

• Difficulty fitting dentures

• Mucosal ulceration over cyst

• Secondary infection signs (redness, warmth)

• Rapid increase in size (acute inflammation)

• Facial or submandibular swelling (plunging ranula)

• Neck mass or cervical extension

• Trismus (limited mouth opening)

• Airway compromise in rare cases

• Weight loss due to feeding difficulty

• Xerostomia (dry mouth from salivary disruption) Children’s Hospital of PhiladelphiaHealthline.

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Diagnostic Tests

1. Clinical Examination

2. Ultrasound – cystic nature assessment

3. Magnetic Resonance Imaging (MRI) – anatomic delineation

4. Computed Tomography (CT) – bone relationships

5. Fine‑Needle Aspiration (FNA) – fluid analysis

6. Sialography – duct visualization

7. Histopathology – epithelial lining identification

8. Panoramic Radiograph – rule out bony lesions

9. Salivary Flow Measurement

10. Genetic Testing (for congenital syndromes)

11. Blood Glucose (diabetes screening)

12. Autoimmune Panels (e.g., ANA for Sjögren’s)

13. Culture & Sensitivity (if infected)

14. Electromyography (rare, muscle involvement)

15. Biopsy of Adjacent Tissue

16. Allergy Testing

17. Endoscopic Salivary Ductoscopy

18. Thyroid Function Tests (for thyroglossal cyst)

19. Neck Ultrasound (cervical extension)

20. Pulmonary Function Tests (if airway at risk) MedscapeRadiopaedia.

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Non‑Pharmacological Treatments

• Warm Compresses under chin

• Manual Massage of floor of mouth

• Good Oral Hygiene (brushing, flossing)

• Hydration (increase saliva flow)

• Dietary Modifications (soft foods)

• Avoidance of Trauma (mouth guards)

• Speech Therapy (to improve movement)

• Physiotherapy (tongue exercises)

• Cryotherapy (local cold application)

• Laser Ablation (CO₂ laser)

• Ultrasound‑Guided Aspiration

• Micro‑Marsupialization (suture‑seton technique)

• Sclerotherapy (OK‑432, bleomycin)

• Observation (small, asymptomatic cysts)

• Acupuncture (symptom relief)

• Transoral Endoscopic Drainage

• Low‑Level Laser Therapy

• Probiotic Lozenges (oral flora modulation)

• Local Heat Therapy

• Osteopathic Techniques

• Mindfulness & Relaxation (reduce bruxism)

• Non‑Contact Cryosurgery

• Laser‑Assisted Marsupialization

• High‑Frequency Ultrasound Ablation

• Transmucosal Photodynamic Therapy

• Manual Lymphatic Drainage

• Acupressure (for pain control)

• Orofacial Myofunctional Therapy

• Postural Training (reduce tongue thrust)

• Upper Airway Exercise (prevent breathing issues) Cleveland ClinicDr Sanu P Moideen.

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 Drugs

1. Ibuprofen (NSAID for pain and inflammation)

2. Acetaminophen (analgesic)

3. Amoxicillin (broad‑spectrum antibiotic)

4. Clindamycin (for penicillin allergy)

5. Augmentin (amoxicillin/clavulanate)

6. Dexamethasone (corticosteroid for swelling)

7. Prednisone (oral steroid taper)

8. Lidocaine Viscous (topical anesthetic)

9. Benzydamine (topical anti‑inflammatory)

10. OK‑432 (sclerosing agent)

11. Bleomycin (sclerotherapy agent)

12. Methotrexate (for autoimmune etiology)

13. Mupirocin Ointment (if secondary skin infection)

14. Nystatin (if fungal involvement)

15. Acyclovir (if herpetic cause)

16. Pilocarpine (salivary stimulant)

17. Sialagogues (e.g., sugar‑free lemon candies)

18. Glyceryl Trinitrate Ointment (to reduce muscle spasm)

19. Botulinum Toxin (adjunct for muscle‑related cysts)

20. Sucralfate Suspension (mucosal protectant) MedscapeCleveland Clinic.

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Surgical Options

1. Marsupialization – unroofing the cyst to allow continuous drainage Cleveland ClinicOptecoto

2. Complete Excision of Cyst – with intact capsule removal

3. Sublingual Gland Excision – for ranula recurrence prevention

4. Submandibular Gland Excision – in plunging ranula cases

5. Laser Excision (CO₂ laser glossotomy) ScienceDirectScholars.Direct

6. Transoral Endoscopic Resection

7. Sclerotherapy Injection – followed by limited excision

8. Cryosurgical Removal

9. Cyst Aspiration + Ethanol Sclerotherapy

10. Open Cervical Approach – for large, plunging cysts BDS NotesScienceDirect.

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Preventive Measures

• Protective Mouthguards during sports

• Gentle Oral Hygiene to avoid mucosal injury

• Regular Dental Check‑Ups for early ductal spotting

• Hydration to keep saliva flowing

• Avoidance of Oral Trauma (hard foods)

• Manage Systemic Diseases (e.g., diabetes control)

• Smoking Cessation

• Limit Alcohol Consumption

• Proper Denture Fitting

• Early Treatment of Salivary Stones Verywell HealthScienceDirect.

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When to See a Doctor

Seek evaluation if you notice:

• Rapid cyst growth or sudden pain

• Difficulty swallowing or speaking

• Airway obstruction signs (shortness of breath)

• Recurrent infections or bleeding

• Fever or systemic symptoms

• New neck swelling alongside oral cyst

• Inability to clear saliva

• Weight loss from feeding issues

• Persistent ulcers over cyst

• Changes in cyst color or consistency Children’s Hospital of PhiladelphiaMedscape.

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Frequently Asked Questions

1. What is a ranula?
   A ranula is a mucus extravasation pseudocyst arising from the sublingual gland, appearing as a bluish, fluctuant swelling under the tongue; a plunging ranula extends into the neck RadiopaediaVerywell Health.

2. How does a dermoid cyst differ from an epidermoid cyst?
   A dermoid cyst contains skin appendages (hair, sebaceous glands) in its lining, whereas an epidermoid cyst lacks these adnexal structures RadiopaediaIU Indianapolis ScholarWorks.

3. Are lymphoepithelial cysts cancerous?
   No—oral lymphoepithelial cysts are benign, developmental lesions with no malignant potential PathologyOutlines.comJOMS.

4. Can small cysts resolve without treatment?
   Tiny, asymptomatic cysts may be observed over time, but most require intervention to prevent growth or complications Children’s Hospital of PhiladelphiaMedscape.

5. Is aspiration enough to cure a ranula?
   Aspiration offers temporary relief but has high recurrence; definitive treatment often involves marsupialization or gland excision Cleveland ClinicOptecoto.

6. When is imaging necessary?
   MRI, CT, or ultrasound is indicated for deep, large, or plunging cysts to map extent and surgical planning MedscapeRadiopaedia.

7. Can cysts interfere with speech?
   Yes—large cysts can alter tongue movement, leading to dysarthria or lisps Scholars.DirectChildren’s Hospital of Philadelphia.

8. What sclerosing agents are used?
   OK‑432 (picibanil) and bleomycin injections have been effective for ranula and lymphangioma‑like cysts Cleveland ClinicScienceDirect.

9. Is general anesthesia required for removal?
   Many intraoral cyst excisions can be done under local anesthesia; larger or cervical approaches often need general anesthesia Scholars.DirectOptecoto.

10. What is the recurrence rate?
    Recurrence varies: up to 50 % for simple marsupialization alone, but < 5 % when the sublingual gland is removed Cleveland ClinicOptecoto.

11. Are cysts painful?
    Typically painless unless secondarily infected or inflamed, at which point tenderness and erythema may occur Children’s Hospital of PhiladelphiaVerywell Health.

12. How soon after surgery can normal diet resume?
    Soft diet is usually recommended for 1–2 weeks post‑op to allow healing and prevent trauma Scholars.DirectCleveland Clinic.

13. Can cysts appear in children?
    Yes—congenital cysts (dermoid, thyroglossal) often present in childhood; ranulas are common in adolescents AcademiaChildren’s Hospital of Philadelphia.

14. Are there non‑surgical cures?
    Observation, sclerotherapy, and laser techniques can avoid open surgery in select cases Cleveland ClinicDr Sanu P Moideen.

15. How is diagnosis confirmed?
    Definitive diagnosis is by histopathology after excision or biopsy, identifying lining epithelium and contents ScienceDirectPathologyOutlines.com.

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

Last Updated: April 17, 2025.

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