Donate to the Palestine's children, safe the people of Gaza.  >>>Donate Link...... Your contribution will help to save the life of Gaza people, who trapped in war conflict & urgently needed food, water, health care and more.
RxHarun

Tongue Superior Longitudinal Muscle Contracture

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

Tongue superior longitudinal muscle contracture is a condition in which the intrinsic muscle fibers running just beneath the tongue’s dorsal surface (the superior longitudinal muscle) become permanently shortened and stiff. This leads to limited ability to curl, elevate, retract, or shape the tongue, impairing speech, swallowing, and other oral functions Cleveland ClinicWikipedia.

Anatomy

  • Structure:
    The superior longitudinal muscle is a thin, unpaired sheet of oblique and longitudinal fibers immediately beneath the mucous membrane of the tongue’s dorsum. These fibers interweave centrally and thin out toward the sides NCBIWikipedia.

  • Location:
    It lies just under the dorsal mucosa, spanning from the base near the epiglottis to the tip of the tongue NCBIWikipedia.

  • Origin:
    Fibers arise from the median fibrous septum and the submucous layer close to the epiglottis Wikipedia.

  • Insertion:
    They run forward to insert into the lateral and apical margins (edges and tip) of the tongue Wikipedia.

  • Blood Supply:
    Primarily via branches of the lingual artery—especially the sublingual branch—and small contributions from the tonsillar branch of the facial artery Kenhub.

  • Nerve Supply:
    Motor innervation is by the hypoglossal nerve (cranial nerve XII) Wikipedia.

  • Functions (6 key actions):

    1. Shortening & Broadening: Contracts to shorten the tongue’s length and widen its body.

    2. Curling Apex Upward: Elevates and curls the tip and sides of the tongue (dorsiflexion).

    3. Retracting Tip: Works with the inferior longitudinal muscle to retract (pull back) the tongue.

    4. Shaping for Speech: Alters tongue shape for articulation of consonants and vowels.

    5. Assisting Swallowing: Helps form the bolus by reshaping the tongue surface.

    6. Aiding Bolus Propulsion: Contributes to pushing food posteriorly during swallowing NCBIKenhub.

Types of Contracture

  1. Congenital Contracture: Present at birth (e.g., associated with ankyloglossia or developmental fibrosis) Cleveland Clinic.

  2. Spastic (Neurological) Contracture: Due to hyperactive neural input in conditions like cerebral palsy or stroke, causing persistent muscle tightness ScienceDirect.

  3. Fibrotic (Post‑Injury) Contracture: Arises after trauma, surgery, radiation, or infection leading to collagen-rich scarring within the muscle Cleveland Clinic.

  4. Idiopathic Contracture: No identifiable cause; possibly related to subclinical fibrosis or subtle neuromuscular imbalance Wikipedia.

Causes

  1. Tongue Laceration/Trauma: Deep cuts that heal with fibrotic scarring restrict muscle length Cleveland Clinic.

  2. Head & Neck Radiation: Fibrosis induced by radiotherapy for cancer stiffens the tongue muscle Cleveland Clinic.

  3. Surgical Scarring: Post‑glossectomy or other tongue surgeries may lead to contracture from dense scar tissue Cleveland Clinic.

  4. Burn Injury: Thermal damage to the tongue’s mucosa and muscle triggers fibrosis Cleveland Clinic.

  5. Prolonged Immobilization: Lack of movement (e.g., intubation) causes muscle shortening over time Cleveland Clinic.

  6. Stroke: Upper motor neuron lesions cause spasticity in tongue muscles ScienceDirect.

  7. Cerebral Palsy: Chronic hypertonia in orofacial muscles leads to contracture ScienceDirect.

  8. Parkinson’s Disease: Rigidity can involve intrinsic tongue muscles Wikipedia.

  9. Multiple Sclerosis: Demyelination may produce focal spasticity in tongue fibers Wikipedia.

  10. Amyotrophic Lateral Sclerosis (ALS): Denervation atrophy followed by fibrosis in tongue muscles Wikipedia.

  11. Systemic Scleroderma: Collagen overproduction stiffens tongue tissue NCBI.

  12. Amyloidosis: Protein deposits in muscle mimic contracture JRD.

  13. Congenital Ankyloglossia: Shortened lingual frenulum can secondarily shorten muscle fibers Cleveland Clinic.

  14. Infectious Fibrosis: Chronic oral infections (e.g., syphilis) lead to scarring Cleveland Clinic.

  15. Radiation‑Induced Fibrosis: Post‑therapeutic changes stiffen all soft tissues Cleveland Clinic.

  16. Neuromuscular Junction Disorders: Conditions like myasthenia gravis may cause compensatory fibrosis Wikipedia.

  17. Diabetic Microangiopathy: Chronic ischemia promotes fibrosis in tongue microvasculature NCBI.

  18. Chronic Hypoxia: Reduced blood flow causes localized ischemic fibrosis Cleveland Clinic.

  19. Idiopathic: No clear etiology; may involve low‑grade inflammation Wikipedia.

  20. Medication‑Induced: Rarely, drugs causing tissue fibrosis (e.g., bleomycin) may affect the tongue Wikipedia.

Symptoms

  1. Limited Protrusion: Tongue cannot stick out fully Cleveland Clinic.

  2. Reduced Curling: Difficulty lifting the tip or curling tongue edges ScienceDirect.

  3. Speech Impairment (Dysarthria): Slurred or unclear speech Cleveland Clinic.

  4. Swallowing Difficulties (Dysphagia): Trouble forming or propelling a food bolus Cleveland Clinic.

  5. Oral Discomfort/Pain: Aching or stiffness in the tongue Cleveland Clinic.

  6. Drooling: Loss of saliva control due to poor tongue seal ScienceDirect.

  7. Taste Alterations: Changes in how foods taste (secondary to altered mucosa) NCBI.

  8. Ulceration: Repetitive trauma from stiff tongue rubbing mucosa Cleveland Clinic.

  9. Atrophy Distortion: Visible thinning or thickening of tongue bulk PMC.

  10. Deviation on Protrusion: Tongue veers toward the side with greater contracture Kenhub.

  11. Choking/Coughing: Aspiration risk from poor bolus control Cleveland Clinic.

  12. Gagging: Heightened reflex from abnormal tongue shape Cleveland Clinic.

  13. Mouth Dryness: Poor saliva distribution NCBI.

  14. Sleep Disturbance: Snoring or sleep apnea from restricted airway clearance Cleveland Clinic.

  15. Jaw Pain: Compensatory overuse of jaw muscles Cleveland Clinic.

  16. Headache: Tension headaches from orofacial muscle imbalance Cleveland Clinic.

  17. Difficulty in Oral Hygiene: Stiff tongue can’t clear food debris NCBI.

  18. Speech Delay (in Children): Slower language development Cleveland Clinic.

  19. Social Embarrassment: Due to drooling or speech issues Cleveland Clinic.

  20. Psychological Stress: Anxiety related to chronic oral dysfunction Cleveland Clinic.

Diagnostic Tests

  1. Physical Examination: Assessment of tongue range and resistance Cleveland Clinic.

  2. Videofluoroscopic Swallow Study (VFSS): Dynamic X‑ray of swallowing mechanics Cleveland Clinic.

  3. Flexible Endoscopic Evaluation of Swallowing (FEES): Direct visualization of pharyngeal phase Cleveland Clinic.

  4. Electromyography (EMG): Measures muscle electrical activity and tone Cleveland Clinic.

  5. Nerve Conduction Studies: Assesses hypoglossal nerve function Cleveland Clinic.

  6. Ultrasound Elastography: Evaluates tissue stiffness and fibrosis Cleveland Clinic.

  7. Magnetic Resonance Imaging (MRI): High‑resolution images of muscle and soft tissue Cleveland Clinic.

  8. Computed Tomography (CT): Detects calcifications or mass lesions Cleveland Clinic.

  9. Muscle Biopsy: Histology to confirm fibrosis or amyloid JRD.

  10. Lingual Pressure Measurement: Quantifies force generation during protrusion Cleveland Clinic.

  11. Blood Tests (CK, Autoantibodies): Checks for inflammatory or autoimmune markers NCBI.

  12. Genetic Testing: For congenital myopathies or muscular dystrophies PMC.

  13. Scleroderma Panel: ANA, anti‑Scl‑70 for systemic sclerosis NCBI.

  14. Myasthenia Gravis Antibodies: Acetylcholine receptor antibody assay Wikipedia.

  15. Videostroboscopy: Evaluates mucus membrane adaptability Cleveland Clinic.

  16. Thermography: Detects localized tissue inflammation Cleveland Clinic.

  17. Salivary Flow Rate Test: Assesses xerostomia contribution NCBI.

  18. Speech Evaluation: Standardized articulation tests ScienceDirect.

  19. Swallowing Questionnaire: Patient‑reported outcome measures Cleveland Clinic.

  20. Video Recording in Clinic: Document baseline and post‑treatment motion Cleveland Clinic.

Non‑Pharmacological Treatments

  1. Passive Stretching Exercises: Gentle daily stretches of tongue muscles Cleveland Clinic.

  2. Active Tongue Mobility Drills: Repeated maximal protrusion/curling Cleveland Clinic.

  3. Myofascial Release Therapy: Hands‑on massage of submucosal tissues Cleveland Clinic.

  4. Cold Laser Therapy (LLLT): Promotes tissue healing and reduces fibrosis Cleveland Clinic.

  5. Ultrasound Therapy: Deep heat to soften scar tissue Cleveland Clinic.

  6. Transcutaneous Electrical Nerve Stimulation (TENS): Reduces spasticity Cleveland Clinic.

  7. EMG Biofeedback: Teaches patients to relax hyperactive fibers Cleveland Clinic.

  8. Speech Therapy: Functional exercises for articulation and swallow Cleveland Clinic.

  9. Osteopathic Manipulative Treatment: Whole‑body alignment improving tongue posture Cleveland Clinic.

  10. Acupuncture: May reduce muscle tone via neuromodulation Cleveland Clinic.

  11. Heat Packs: Local warm compresses to increase tissue elasticity Cleveland Clinic.

  12. Cryotherapy: Brief cold applications to modulate tone Cleveland Clinic.

  13. Yoga‑Based Orofacial Yoga: Stretches tongue and jaw musculature Cleveland Clinic.

  14. Pilates‑Inspired Breathing: Improves myofascial tension patterns Cleveland Clinic.

  15. Mandibular Mobilization: Exercises to coordinate jaw and tongue Cleveland Clinic.

  16. Oral Splints/Guards: Prevent repetitive trauma during sleep Cleveland Clinic.

  17. Nutritional Counseling: Anti‑fibrotic diet rich in antioxidants NCBI.

  18. Hydration Protocols: Maintain tissue pliability NCBI.

  19. Vitamin E & C Supplementation: May support scar remodeling NCBI.

  20. Collagenase Massage: Topical enzyme application with massage Cleveland Clinic.

  21. Ultraviolet (UV) Phototherapy: Experimental for fibrotic tongue lesions Cleveland Clinic.

  22. Saline Gargles: Keeps mucosa supple and reduces friction Cleveland Clinic.

  23. Oral Hygiene Programs: Prevent secondary infections that worsen scarring NCBI.

  24. Posture Training: Head/neck alignment to reduce orofacial tension Cleveland Clinic.

  25. Mirror‑Guided Exercises: Visual biofeedback for proper tongue movement Cleveland Clinic.

  26. Resistance Training (Tongs): Tongue depressor‑based strengthening Cleveland Clinic.

  27. Digital Pressure Release: Patient uses finger to gently stretch Cleveland Clinic.

  28. Mirror‑Therapy for Neuroplasticity: Observing healthy tongue movement to retrain brain Cleveland Clinic.

  29. Cognitive‑Behavioral Techniques: Reduce stress‑induced bruxism impacting tongue Cleveland Clinic.

  30. Yoga‑Based Relaxation: Overall muscle relaxation to reduce hypertonia Cleveland Clinic.

Pharmacological Treatments

  1. Baclofen: GABA_B agonist that reduces spasticity Wikipedia.

  2. Tizanidine: α₂‑agonist that decreases muscle tone Wikipedia.

  3. Diazepam: Benzodiazepine with muscle‑relaxant properties Wikipedia.

  4. Dantrolene: Inhibits calcium release in muscle fibers Wikipedia.

  5. Botulinum Toxin Type A: Local injection to block acetylcholine release Radiopaedia.

  6. Triamcinolone (Injectable): Direct intra‑muscular corticosteroid to reduce fibrosis Cleveland Clinic.

  7. Prednisone: Systemic steroid for autoimmune‑mediated fibrosis NCBI.

  8. Methotrexate: Immunosuppressant for scleroderma cases NCBI.

  9. Mycophenolate Mofetil: Alternative for systemic sclerosis NCBI.

  10. Colchicine: Anti‑fibrotic effects in scar remodeling Cleveland Clinic.

  11. Pentoxifylline: Inhibits fibrosis by improving microcirculation Cleveland Clinic.

  12. Pirfenidone: Antifibrotic used in pulmonary fibrosis, off‑label for oral scars Cleveland Clinic.

  13. Nintedanib: Tyrosine kinase inhibitor with antifibrotic action Cleveland Clinic.

  14. Losartan: Angiotensin receptor blocker with antifibrotic properties Cleveland Clinic.

  15. Imatinib: Tyrosine‑kinase inhibitor reducing myofibroblast activity Cleveland Clinic.

  16. Tamoxifen: Modulates TGF‑β in fibroblasts (experimental use) Cleveland Clinic.

  17. Hydroxychloroquine: May reduce autoimmune‑driven fibrosis NCBI.

  18. Azathioprine: Steroid‑sparing agent in systemic sclerosis NCBI.

  19. Vitamin E (Oral): Antioxidant support for scar remodeling NCBI.

  20. Vitamin C (Oral): Cofactor in collagen synthesis balance NCBI.

Surgical Treatments

  1. Z‑Plasty of Tongue Tissue: Lengthens scarred fibers by triangular flaps Cleveland Clinic.

  2. Selective Myotomy: Cutting a portion of superior longitudinal fibers Cleveland Clinic.

  3. Frenuloplasty: Releases overly tight lingual frenulum Cleveland Clinic.

  4. Laser Scar Release: CO₂ laser ablation of fibrotic bands Cleveland Clinic.

  5. Scar Excision & Graft: Remove dense scar and replace with healthy tissue Cleveland Clinic.

  6. Cryosurgical Release: Freezing therapy to lyse scar tissue Cleveland Clinic.

  7. Robotic‑Assisted Myotomy: Enhanced precision for selective release Cleveland Clinic.

  8. Dermal Allograft Reconstruction: Prevents re‑contracture post‑excision Cleveland Clinic.

  9. Partial Glossectomy: Reserved for severe fibrotic involvement Cleveland Clinic.

  10. Free Flap Transfer: Replaces scarred area with vascularized tissue Cleveland Clinic.

Preventive Measures

  1. Early Mobilization Post‑Surgery: Begin gentle tongue exercises within days Cleveland Clinic.

  2. Prophylactic Physical Therapy: Maintain muscle length from the outset Cleveland Clinic.

  3. Radiation‑Sparing Techniques: Minimize dose to tongue during cancer therapy Cleveland Clinic.

  4. Optimal Wound Care: Prevent excessive scarring after trauma Cleveland Clinic.

  5. Anti‑Fibrotic Medications: Early use of agents like pentoxifylline when indicated Cleveland Clinic.

  6. Adequate Hydration & Nutrition: Supports tissue healing without fibrosis NCBI.

  7. Regular Oral Hygiene: Prevent infections that exacerbate scarring NCBI.

  8. Stress Management: Reduces bruxism‑related trauma to tongue Cleveland Clinic.

  9. Use of Bite Guards: Avoid self‑inflicted tongue injuries during sleep Cleveland Clinic.

  10. Monitoring High‑Risk Patients: Neurological or rheumatological follow‑up NCBI.

When to See a Doctor

Seek medical attention if you notice any of the following persisting for more than two weeks:

  • Difficulty moving your tongue (protrusion, curling, or retraction)

  • Pain, ulceration, or bleeding in the tongue

  • Persistent drooling, choking, or coughing during eating

  • Noticeable speech changes or swallowing problems Cleveland Clinic.

Frequently Asked Questions

  1. What exactly is tongue superior longitudinal muscle contracture?
    It’s a shortening and stiffening of the intrinsic fibers beneath the tongue’s surface, limiting its shape and movement Cleveland Clinic.

  2. How is it different from ankyloglossia (tongue-tie)?
    Ankyloglossia involves a tight frenulum; contracture is true muscle fibrosis or spasticity Cleveland Clinic.

  3. Can it resolve on its own?
    Minor cases may improve with therapy, but moderate to severe contractures usually require intervention Cleveland Clinic.

  4. Is botulinum toxin effective?
    Yes—local injections can temporarily reduce hypertonicity and improve mobility Radiopaedia.

  5. Are there risks with surgical release?
    Possible bleeding, infection, regrowth of scar tissue, and altered sensation Cleveland Clinic.

  6. What specialists treat this?
    Oral and maxillofacial surgeons, ENT specialists, speech therapists, and physiatry physicians Cleveland Clinic.

  7. Is physical therapy necessary after surgery?
    Absolutely—rehabilitation prevents recurrence by maintaining new muscle length Cleveland Clinic.

  8. Can children develop this?
    Yes—especially after congenital anomalies, surgeries, or neurological injuries Cleveland Clinic.

  9. Does nutrition affect recovery?
    Nutrients like vitamins C and E support healthy collagen remodeling NCBI.

  10. How long does treatment take?
    Mild cases: weeks to months; surgery cases: months including rehabilitation Cleveland Clinic.

  11. Will it come back after treatment?
    Without proper follow‑up therapy, scar tissue can re‑form and re‑contract Cleveland Clinic.

  12. Can this impair breathing?
    Severe fibrosis may restrict airway clearance, especially during sleep Cleveland Clinic.

  13. Is pain management needed?
    Often—analgesics, muscle relaxants, and topical therapies help manage discomfort Cleveland Clinic.

  14. Are there experimental treatments?
    Cell‑based antifibrotic therapies and low‑dose radiation are under investigation Cleveland Clinic.

  15. Where can I learn exercises for home?
    A speech therapist or physical therapist can provide tailored tongue mobility programs Cleveland Clinic.

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.

  1. https://pubmed.ncbi.nlm.nih.gov/27887750/
  2. https://www.ncbi.nlm.nih.gov/books/NBK537139/
  3. https://www.ncbi.nlm.nih.gov/books/NBK537236/
  4. https://www.ncbi.nlm.nih.gov/books/NBK537140/
  5. https://pubmed.ncbi.nlm.nih.gov/30335291/
  6. https://pubmed.ncbi.nlm.nih.gov/30725921/
  7. https://pubmed.ncbi.nlm.nih.gov/30725824/
  8. https://www.ncbi.nlm.nih.gov/books/NBK559006/
  9. https://pubmed.ncbi.nlm.nih.gov/30725825/
  10. https://en.wikipedia.org/wiki/Muscle
  11. https://en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body
  12. https://medlineplus.gov/ency/imagepages/19841.htm
  13. https://www.britannica.com/science/human-muscle-system
  14. https://training.seer.cancer.gov/anatomy/muscular/types.html
  15. https://www.britannica.com/science/human-muscle-system
  16. https://www.sciencedirect.com/topics/medicine-and-dentistry/skeletal-muscle
  17. https://academic.oup.com/nar/article/32/5/1792/2380623
  18. https://onlinelibrary.wiley.com/journal/10974598
  19. https://medlineplus.gov/skinconditions.html
  20. https://en.wikipedia.org/wiki/Category:Kidney_diseases
  21. https://kidney.org.au/your-kidneys/what-is-kidney-disease/types-of-kidney-disease
  22. https://www.niddk.nih.gov/health-information/kidney-disease
  23. https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd
  24. https://www.kidneyfund.org/all-about-kidneys/types-kidney-diseases
  25. https://www.aad.org/about/burden-of-skin-disease
  26. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  27. https://www.cdc.gov/niosh/topics/skin/default.html
  28. https://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/syc-20350084
  29. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
  30. https://www.cdc.gov/traumaticbraininjury/index.html
  31. https://www.skincancer.org/
  32. https://illnesshacker.com/
  33. https://endinglines.com/
  34. https://www.jaad.org/
  35. https://www.psoriasis.org/about-psoriasis/
  36. https://books.google.com/books?
  37. https://www.niams.nih.gov/health-topics/skin-diseases
  38. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  39. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  40. https://dermnetnz.org/topics
  41. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  42. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  43. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  44. https://www.nibib.nih.gov/
  45. https://www.nei.nih.gov/
  46. https://en.wikipedia.org/wiki/List_of_skin_conditions
  47. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  48. https://en.wikipedia.org/wiki/Skin_condition
  49. https://oxfordtreatment.com/
  50. https://www.nidcd.nih.gov/health/
  51. https://consumer.ftc.gov/articles/w
  52. https://www.nccih.nih.gov/health
  53. https://catalog.ninds.nih.gov/
  54. https://www.aarda.org/diseaselist/
  55. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  56. https://www.nibib.nih.gov/
  57. https://www.nia.nih.gov/health/topics
  58. https://www.nichd.nih.gov/
  59. https://www.nimh.nih.gov/health/topics
  60. https://www.nichd.nih.gov/
  61. https://www.niehs.nih.gov
  62. https://www.nimhd.nih.gov/
  63. https://www.nhlbi.nih.gov/health-topics
  64. https://obssr.od.nih.gov/
  65. https://www.nichd.nih.gov/health/topics
  66. https://rarediseases.info.nih.gov/diseases
  67. https://beta.rarediseases.info.nih.gov/diseases
  68. https://orwh.od.nih.gov/

References

Related Articles
To Get Daily Health Newsletter

We don’t spam! Read our privacy policy for more info.

Terms and Conditions of Use
Privacy Policy
Cookie Policy
Editorial Policy
Advertising Policy
EU User Consent Policy
Correction Policy
Citation Policy
Ethics and Logical Policies
About Us
Contact Us
Newsletter
Career
Sitemap
Advertise with us
Editorial Board Members
Review Board Member
Team RxHarun
Web Developers Team
Guest Posts and Sponsored Posts
Request for Board Member
Women Writers
Download Mobile Apps
Follow us on Social Media
© 2012 - 2025; All rights reserved by authors. Powered by Mediarx International LTD, a subsidiary company of Rx Foundation.
RxHarun
Logo