Tongue Superior Longitudinal Muscle Sprain

A tongue superior longitudinal muscle sprain is a rare injury in which the intrinsic superior longitudinal fibers of the tongue are overstretched or torn. Although “sprain” traditionally refers to ligaments, in this context the term describes a muscle injury—also known as a strain—of the thin layer just beneath the mucous membrane on the dorsal tongue surface Mayo ClinicUPMC | Life Changing Medicine. Such an injury can range from microscopic fiber overstretching (Grade I) to partial (Grade II) or complete fiber tears (Grade III) Nationwide Children’s Hospital.

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Anatomy

Structure & Location

• The superior longitudinal muscle is one of four intrinsic tongue muscles, lying immediately under the mucosa on the dorsal surface. It forms a continuous sheet from the root to the apex, superior to the transverse and vertical intrinsic muscles NCBIRadiopaedia.

Origin

• Fibers arise from the median fibrous septum and the submucosal fibrous layer close to the epiglottis Wikipedia.

Insertion

• Fibers run forward to insert into the edges and apex of the tongue, blending with mucosa and connective tissue RadiopaediaWikipedia.

Blood Supply

• Receives arterial blood from the lingual artery, a branch of the external carotid artery, with sublingual and deep lingual branches nourishing the muscle Kenhub.

Nerve Supply

• Motor innervation is via the hypoglossal nerve (CN XII), which controls all intrinsic and most extrinsic tongue muscles Wikipedia.

Key Functions

1. Shortening the tongue body, making it thicker and more compact

2. Widening the tongue by reducing its length

3. Elevating the tip and lateral margins (dorsiflexion)

4. Assisting in retraction when acting with the inferior longitudinal muscle

5. Aiding in precise articulation for speech clarity

6. Optimizing tongue shape for bolus formation during chewing and swallowing NCBIRadiopaedia.

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Types of Sprain

• Grade I (Mild): Minimal fiber overstretching without significant tearing; minimal functional loss Nationwide Children’s Hospital.

• Grade II (Moderate): Partial fiber tearing; moderate pain, swelling, and functional limitation Nationwide Children’s Hospital.

• Grade III (Severe): Complete disruption of muscle fibers; severe pain, marked hematoma, and significant loss of function Nationwide Children’s Hospital.

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Causes

Common precipitating factors include oral trauma, overuse, and iatrogenic injury:

1. Accidental tongue biting during talking or seizures

2. Sports-related impacts to the mouth (e.g., ball strikes)

3. Dental instrument slips during procedures

4. Traumatic intubation in surgery or emergency care

5. Sharp-object penetration (e.g., broken tooth fragment)

6. Aggressive speech therapy exercises without warm‑up

7. Repeated vomiting increasing intraoral pressure

8. Chemical burns weakening muscle fibers

9. Thermal burns from excessively hot foods

10. Oral piercings that inflame or tear tissue

11. Penetrating wounds from accidental falls

12. Iatrogenic surgical trauma in glossectomy or frenuloplasty

13. Orthodontic appliance irritation

14. Tongue thrust habits in children

15. Severe coughing fits leading to muscle fatigue

16. Radiation therapy–induced tissue fragility

17. Inadequate hydration causing reduced tissue resilience

18. Bruxism (teeth grinding) causing repetitive trauma

19. Forceful sneezing with mouth closed

20. Neuromuscular disorders causing sudden, uncontrollable movements Mayo ClinicHealth.

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Symptoms

Injury to the superior longitudinal muscle typically presents with:

1. Dull ache or sharp pain on tongue movement

2. Tenderness on palpation of the dorsal tongue

3. Swelling or subtle mucosal bulge

4. Bruising (submucosal hematoma)

5. Difficulty curling or elevating tongue tip

6. Reduced protrusion of the tongue

7. Stiffness when speaking or swallowing

8. Muscle spasms or twitching

9. Fatigue with prolonged speech tasks

10. Burning sensation under the tongue surface

11. Radiating pain to the jaw or throat

12. Excessive salivation or drooling

13. Dysarthria (slurred speech)

14. Dysphagia (difficulty swallowing)

15. Impaired bolus control during chewing

16. Clicking or snapping sensation on movement

17. Visible fiber tear under high magnification (rare)

18. Altered taste sensation if severe

19. Asymmetry in tongue shape at rest

20. Psychological distress due to persistent discomfort Mayo Clinic.

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Diagnostic Tests

A combination of clinical and imaging studies aids diagnosis:

1. Detailed medical history and symptom chronology

2. Physical examination with gentle tongue palpation

3. Visual inspection under good lighting

4. Video fluoroscopic swallowing study (VFSS)

5. Fiberoptic endoscopic evaluation of swallowing (FEES)

6. Ultrasound imaging of tongue musculature Radiopaedia

7. MRI of the tongue to visualize fiber tears Radiopaedia

8. CT scan for bone or foreign‑body assessment

9. Electromyography (EMG) of tongue muscles

10. Nerve conduction studies for CN XII integrity

11. Tongue pressure measurement tools

12. Flexible intraoral endoscopy

13. Ultrasound elastography for tissue stiffness

14. Dynamic MRI during tongue movement

15. Swallowing manometry

16. Ultrasonographic Doppler for blood flow

17. High‑resolution endoscopic imaging

18. Muscle biopsy (rare, for chronic cases)

19. Blood tests to rule out systemic myopathies

20. Allergy testing if chemical burn suspected Physiopedia.

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Non‑Pharmacological Treatments

Early and progressive conservative care supports healing:

1. Voice rest to minimize tongue movement

2. Soft‑diet (pureed foods) to reduce chewing strain

3. Cold external compresses to control swelling

4. Warm external compresses after acute phase

5. Intraoral gentle massage by a therapist

6. Speech‑language pathology–guided stretching

7. Myofunctional therapy exercises

8. Therapeutic ultrasound

9. Low‑level laser therapy (LLLT)

10. Transcutaneous electrical nerve stimulation (TENS)

11. Acupuncture at peri‑oral points

12. Progressive isometric strengthening

13. Relaxation/breathing exercises

14. Postural correction (neck/trunk alignment)

15. Hydration protocols (humidified air)

16. Nutritional optimization (protein, vitamins)

17. Avoidance of spicy/acidic foods

18. Custom‑fit bite guard for nighttime use

19. Biofeedback during tongue exercise

20. Myofascial release by oral therapist

21. Jaw and neck stretching to reduce compensatory tension

22. Warm saline mouth rinses

23. Cool chamomile rinses for comfort

24. Cryokinetics (cold + gentle motion)

25. Controlled active stretching

26. Non‑slip tongue pads during therapy

27. Phonophoresis (ultrasound‑mediated topical therapy)

28. Whole‑body relaxation/yoga

29. Heat‑pack masks for intraoral warming

30. Tongue rest splints to limit motion Health.

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Drugs

When indicated, pharmacotherapy may include:

1. Ibuprofen (NSAID) for pain/inflammation

2. Naproxen (NSAID)

3. Aspirin (NSAID)

4. Acetaminophen (analgesic)

5. Diclofenac (topical/oral NSAID)

6. Ketorolac (short‑term NSAID)

7. Celecoxib (COX‑2 inhibitor)

8. Indomethacin (NSAID)

9. Prednisone (oral corticosteroid) for severe inflammation

10. Methylprednisolone (IV corticosteroid)

11. Cyclobenzaprine (muscle relaxant)

12. Tizanidine (alpha‑2 agonist muscle relaxant)

13. Baclofen (GABA agonist)

14. Methocarbamol (central muscle relaxant)

15. Carisoprodol (short‑term muscle relaxant)

16. Diazepam (benzodiazepine muscle relaxant)

17. Topical lidocaine gel (local anesthetic)

18. Amlexanox oral paste (anti‑inflammatory)

19. Hyoscine butylbromide (antispasmodic)

20. Botulinum toxin injection (for refractory spasm) Mayo ClinicHospital for Special Surgery.

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Surgeries

Surgical intervention is rare, reserved for severe or non‑healing tears:

1. Primary suture repair of torn muscle fibers

2. Fibrin glue augmentation for micro‑tears

3. Microvascular flap reconstruction in large defects

4. Debridement of necrotic tissue in chronic cases

5. Tenolysis (adhesion release) under the tongue

6. Z‑plasty for scar contracture

7. Frenuloplasty if ankyloglossia contributes to strain

8. Partial glossectomy for intractable fibrosis

9. Free flap transfer for massive tissue loss

10. Neurotomy/neurectomy of aberrant branches in chronic pain Summa Health.

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Prevention Strategies

Proactive measures to minimize risk:

1. Warm-up exercises before speech therapy or singing

2. Use of custom mouthguards in contact sports

3. Gentle stretching of tongue muscles daily

4. Adequate hydration to maintain tissue resilience

5. Soft‑diet intervals during intensive therapy

6. Avoidance of spicy/acidic/very hot foods

7. Proper technique during intubation or dental work

8. Regular oral self‑exams to detect early injury

9. Routine dental checkups to prevent sharp edges

10. Education on safe tongue exercises Mayo Clinic.

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When to See a Doctor

Seek professional care if you experience:

• Severe or worsening pain unrelieved by OTC measures

• Persistent swelling or hematoma beyond 72 hours

• Marked difficulty swallowing or speaking

• Numbness or altered sensation in the tongue

• Signs of infection: fever, redness, purulent discharge

• Functional impairment interfering with nutrition

• Visible deformity of the tongue surface

• No improvement after conservative care for 7–10 days Mayo Clinic.

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Frequently Asked Questions

1. What exactly is a tongue superior longitudinal muscle sprain?
   It’s an overstretch or tear of the upper intrinsic tongue fibers, causing pain and functional loss during movement Mayo Clinic.

2. How long does it take to heal?
   Mild cases (Grade I) heal in 1–2 weeks; moderate (Grade II) in 3–6 weeks; severe (Grade III) may take 2–3 months or require surgery Nationwide Children’s Hospital.

3. Can I speak normally afterward?
   Most recover full speech. Early rest and guided therapy prevent persistent articulation issues Yale Medicine.

4. What foods should I avoid?
   Hard, sharp, spicy, acidic, or very hot foods that irritate the healing tissue Mayo Clinic.

5. Does R.I.C.E. apply to tongue sprains?
   Rest and ice do help, but compression and elevation are less practical intraorally—external cold packs are preferred Mayo Clinic.

6. Can I exercise my tongue during healing?
   Only guided, gentle stretches under a speech‑therapist’s supervision after the acute phase Nationwide Children’s Hospital.

7. When should I see an ENT specialist?
   If pain, swelling, or functional loss persists > 10 days or worsens despite conservative care Mayo Clinic.

8. Will I have permanent damage?
   Rarely—complete tears have the highest risk, but timely repair yields good outcomes Nationwide Children’s Hospital.

9. Are there natural remedies that help?
   Warm saline rinses, chamomile tea rinses, and gentle massage may offer symptomatic relief Summa Health.

10. How is it diagnosed?
    Clinical exam plus imaging (ultrasound, MRI) confirm tear severity Radiopaedia.

11. Do I always need imaging?
    Not for mild cases; reserved for moderate–severe or unclear injuries Mayo Clinic.

12. Can it recur?
    Yes, without proper therapy and prevention; adherence to rehab protocols is crucial Nationwide Children’s Hospital.

13. Is surgery ever needed?
    Only for Grade III tears that don’t respond to conservative care by 6 weeks Summa Health.

14. How can I prevent it in the future?
    Daily warm‑up, proper technique during oral activities, and use of protective gear Mayo Clinic.

15. Will botulinum toxin help with muscle spasms?
    In refractory cases with persistent spasms, targeted injections can be considered under specialist guidance Hospital for Special Surgery.

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Last Updated: April 22, 2025.

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