Tongue Transverse Muscle Atrophy

Tongue transverse muscle atrophy is the wasting away or thinning of the transverse intrinsic fibers of the tongue, resulting in a loss of muscle mass and strength in that region. This condition can impair the tongue’s ability to change shape, narrow, and elongate, leading to difficulties with speech articulation, swallowing, and food manipulation .

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Anatomy of the Transverse Muscle of the Tongue

Structure & Location

The transverse muscle is one of the four paired intrinsic muscles embedded entirely within the tongue’s substance. Its fibers run horizontally from the midline septum to the lateral margins of the tongue, forming much of its core mass .

Origin

Fibers of the transverse muscle arise from the median fibrous septum, a vertical connective‐tissue partition dividing the tongue into symmetrical halves .

Insertion

These fibers extend laterally to blend into the submucous fibrous tissue at the sides of the tongue, merging with surrounding muscle and mucosa .

Blood Supply

The tongue’s intrinsic muscles receive arterial blood primarily from the lingual artery, a branch of the external carotid artery. Its deep and dorsal lingual branches supply the muscle fibers, with collateral flow from the facial and ascending pharyngeal arteries .

Nerve Supply

Motor innervation is provided by the hypoglossal nerve (cranial nerve XII), which controls all intrinsic tongue muscles except the palatoglossus .

Key Functions

1. Elongation: Lengthens the tongue for protrusion and contact with anterior oral structures.

2. Narrowing: Reduces tongue width to form a midline groove, aiding in bolus control.

3. Articulation: Shapes the tongue during speech to produce consonants and vowels.

4. Bolus Formation: Helps mix food with saliva and form a cohesive mass for swallowing.

5. Propulsion: Assists in moving the bolus posteriorly to trigger the swallowing reflex.

6. Oral Clearance: Aids in cleaning food debris from the teeth and mucosa .

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Types of Atrophy

1. Physiologic (Disuse) Atrophy: Muscle fibers shrink from inactivity or immobilization, such as after prolonged bed rest .

2. Pathologic Atrophy: Occurs with systemic illnesses (e.g., Cushing’s, malnutrition, aging), where disease processes directly drive muscle wasting .

3. Neurogenic Atrophy: Caused by damage to the hypoglossal nerve or central motor pathways (e.g., ALS, nerve injury), leading to rapid and severe fiber loss .

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Causes

1. Hypoglossal Nerve Palsy: Injury or compression of CN XII from tumors or vascular events .

2. Amyotrophic Lateral Sclerosis (ALS): Degeneration of motor neurons leads to progressive tongue wasting .

3. Stroke: Brainstem infarcts can interrupt hypoglossal pathways, causing unilateral atrophy .

4. Spinal Muscular Atrophy: Genetic loss of lower motor neurons leads to early tongue and limb atrophy .

5. Guillain–Barré Syndrome: Acute demyelination may involve cranial nerves, including CN XII .

6. Peripheral Nerve Trauma: Surgery or injury in the submandibular triangle can sever hypoglossal fibers .

7. Diabetes Mellitus: Chronic hyperglycemia causes peripheral neuropathy affecting tongue innervation .

8. Radiation Therapy: Head and neck radiation can damage muscles and nerves, leading to fibrosis and atrophy .

9. Myasthenia Gravis: Autoimmune disorder causing fatigable weakness of tongue muscles .

10. Muscular Dystrophies: Genetic myopathies result in intrinsic muscle degeneration .

11. Cachexia (Cancer, AIDS): Systemic catabolism leads to severe muscle wasting .

12. Age-Related Sarcopenia: Natural decline in muscle mass and function with aging .

13. Endocrine Disorders: Hypothyroidism and Cushing’s syndrome can induce muscle atrophy .

14. Nutritional Deficiencies: Protein-calorie malnutrition impairs muscle maintenance .

15. Chronic Alcoholism: Direct toxic effects on muscle and nerve contribute to wasting .

16. Immobilization: Prolonged tongue rest (e.g., due to intubation) leads to disuse .

17. Autoimmune Myositis: Inflammatory myopathies (e.g., polymyositis) can involve tongue muscles .

18. Chemotherapy: Certain agents cause neurotoxicity and muscle damage .

19. Congenital Hypoplasia: Developmental underdevelopment of tongue intrinsic muscles .

20. Idiopathic: In some cases, no clear cause is identified after thorough evaluation .

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Symptoms

1. Tongue Weakness: Difficulty moving tongue side-to-side or protruding.

2. Fasciculations: Visible twitching of muscle fibers on the tongue surface.

3. Tongue Deviation: On protrusion, the tongue veers toward the weaker side.

4. Dysarthria: Slurred or slowed speech due to impaired articulation.

5. Dysphagia: Trouble forming or moving food bolus, choking or coughing while eating.

6. Drooling: Inability to clear saliva effectively.

7. Taste Disturbances: Altered taste perception due to reduced mucosal movement.

8. Oral Residue: Food remnants stick to sides or roof of mouth.

9. Malnutrition: Weight loss from inadequate oral intake.

10. Aspiration: Food or liquid entering airway, risking pneumonia.

11. Pain or Discomfort: Soreness from overuse of compensatory muscles.

12. Oral Ulcers: Trauma from inadvertent biting of a numb, atrophied tongue.

13. Choking Episodes: Sudden difficulty handling secretions or food.

14. Weak Chewing: Reduced ability to manipulate food on molars.

15. Voice Changes: Breathy or hoarse voice from saliva pooling.

16. Fatigue: Tiredness during meals or prolonged speech.

17. Speech Sound Errors: Difficulty with “l,” “r,” and “th” sounds.

18. Reduced Oral Hygiene: Food accumulation leading to bad breath.

19. Throat Clearing: Frequent clearing to manage secretions.

20. Social Withdrawal: Avoidance of eating or talking in public .

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Diagnostic Tests

1. Clinical Oral Exam: Inspection and palpation to detect atrophy.

2. Electromyography (EMG): Measures muscle electrical activity for denervation .

3. Nerve Conduction Studies: Assess speed of hypoglossal nerve signals.

4. MRI of Brainstem/Tongue: Visualizes structural lesions and fatty infiltration .

5. Ultrasound Imaging: Quantifies muscle thickness and echo texture.

6. CT Scan: Detects mass lesions along the nerve pathway.

7. Videofluoroscopic Swallow Study: Evaluates bolus flow and aspiration risk .

8. Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Direct laryngoscopic view of swallow.

9. Muscle Biopsy: Histology for myopathies or inflammatory changes.

10. Blood Tests: CK, TSH, glucose, nutritional markers (albumin, B12).

11. Autoimmune Panels: ANA, anti–Jo-1 for myositis.

12. Genetic Testing: For SMA or muscular dystrophy.

13. CSF Analysis: When Guillain–Barré is suspected.

14. Videokymography: High‐speed imaging of tongue surface.

15. Speech‐Language Evaluation: Standardized tests of articulation and strength.

16. Nutritional Assessment: Dietician evaluation of intake and deficiency.

17. Pulmonary Function Tests: Assess respiratory muscle involvement.

18. Swallowing Quality of Life Scales: Patient‐reported outcome measures.

19. Electroneuromyography of Other Sites: Rule out generalized neuropathy.

20. Psychological Screening: For depression or social impact.

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Non-Pharmacological Treatments

(Most adapted from oropharyngeal dysphagia protocols , plus targeted exercises and physiotherapy guidelines .)

1. Effortful Swallow Maneuver

2. Mendelsohn Maneuver

3. Masako (Tongue‐Hold) Exercise

4. Supraglottic Swallow

5. Shaker (Head Lift) Exercise

6. Tongue Resistance Exercises (Press Against Spoon)

7. Expiratory Muscle Strength Training (EMST)

8. Neuromuscular Electrical Stimulation (NMES)

9. Biofeedback (Visual or EMG‐Guided)

10. Acupuncture

11. Myofunctional Therapy

12. Manual Tongue Stretching

13. Thermal–Tactile Stimulation

14. Carbonated/Bolus Sensory Stimulation

15. Thickened Liquids / IDDSI Diet

16. Postural Adjustments (Chin‐Tuck, Head Rotation)

17. Diet Texture Modification

18. Feeding Environment Control (Minimize Distractions)

19. Oral Motor Warm‐Ups

20. Cognitive Strategies (Pacing, Small Bites)

21. Grounding and Relaxation Techniques

22. Speech‐Language Therapy

23. Swallowing Maneuvers for Airway Protection

24. Partial Jaw Opening Exercises

25. Respiratory‐Swallow Coordination Training

26. Pharyngeal Strengthening Exercises

27. Chewing Gum Therapy (Mild Resistance)

28. Hydration Optimization

29. Orofacial Massage

30. Therapeutic Listening / Rhythmic Cueing

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Drugs

1. Riluzole: Slows ALS progression by modulating glutamate Wikipedia.

2. Edaravone: Antioxidant therapy for ALS.

3. Prednisone: Corticosteroid for inflammatory myopathies.

4. Azathioprine: Immunosuppressant in polymyositis.

5. Methotrexate: Disease‐modifying agent in autoimmune myositis.

6. Mycophenolate Mofetil: Maintenance immunosuppression.

7. Intravenous Immunoglobulin (IVIG): For immune‐mediated neuropathies.

8. Rituximab: Anti‐CD20 therapy in refractory myositis.

9. Pyridostigmine: Cholinesterase inhibitor in myasthenia gravis.

10. Neostigmine: Short‐acting cholinesterase inhibitor.

11. Glycopyrrolate: Anticholinergic to reduce drooling.

12. Scopolamine: Transdermal antimuscarinic for sialorrhea.

13. Botulinum Toxin: Injections into salivary glands to manage drool.

14. Pilocarpine: Salivary stimulant for dry mouth.

15. Cevimeline: Muscarinic agonist for xerostomia.

16. Gabapentin: Neuropathic pain control.

17. Amitriptyline: Neuropathic pain and sialorrhea management.

18. Coenzyme Q10: Nutraceutical for muscle health.

19. Creatine Monohydrate: Adjunct for muscle strength.

20. Testosterone (Low Dose): Anabolic support in select patients.

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Surgeries

1. Hypoglossal Nerve Decompression: Release entrapment in skull base.

2. Nerve Grafting: Reconstruction after nerve injury.

3. Functional Free‐Flap Transfer: e.g., gracilis muscle for tongue reconstruction.

4. Partial Glossectomy & Reconstruction: For segmental muscle loss.

5. Submandibular Duct Relocation: To reduce aspiration in severe drooling.

6. Salivary Gland Excision: Remove overactive glands causing sialorrhea.

7. Hypoglossal‐Facial Nerve Anastomosis: For reinnervation in palsy.

8. Genioglossus Advancement: Used in obstructive sleep apnea with tongue base collapse.

9. Cricopharyngeal Myotomy: Improves swallow coordination.

10. Feeding Tube Placement (PEG): For severe dysphagia to maintain nutrition.

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Prevention Strategies

1. Early Mobilization: Tongue‐exercise programs after surgery.

2. Good Glycemic Control: Prevent diabetic neuropathy.

3. Nutritional Optimization: Adequate protein and calories.

4. Oral Hygiene: Minimize infections and trauma.

5. Protective Headgear: Prevent cranial nerve injury.

6. Radiation Shielding: During head/neck treatments.

7. Regular Neurological Check‐ups: For early nerve lesion detection.

8. Stress Management: Reduce muscle tension and fatigue.

9. Avoidance of Alcoholism: Prevent toxic neuropathy.

10. Age‐Appropriate Exercise: Combat sarcopenia.

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When to See a Doctor

• New or worsening tongue weakness or deviation

• Persistent difficulty with speech or swallowing

• Unexplained drooling or choking episodes

• Rapid onset of fasciculations on the tongue

• Significant weight loss from eating difficulties

• Signs of aspiration pneumonia (coughing, fever)

• Chronic dry mouth or sialorrhea impacting quality of life

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Frequently Asked Questions

1. What is tongue transverse muscle atrophy?
   A loss of bulk in the horizontal fibers of the tongue, leading to thinning and weakness.

2. Can it be reversed?
   Early stages from disuse may improve with exercises; neurogenic forms are usually permanent.

3. How is it diagnosed?
   Through clinical exam, EMG, imaging (MRI/ultrasound), and sometimes biopsy.

4. What symptoms should I watch for?
   Difficulty speaking, swallowing, tongue deviation, drooling, or fasciculations.

5. Are there specific exercises?
   Yes—tongue‐hold (Masako), resistance presses, and swallow maneuvers guided by a speech therapist.

6. Can medications help rebuild muscle?
   No drug directly regrows muscle; treatments target underlying causes (e.g., immunosuppressants).

7. Is surgery an option?
   In select cases (nerve grafting, free‐flap transfer) to restore some function.

8. Will I need a feeding tube?
   Only if swallowing becomes unsafe or nutrition cannot be maintained orally.

9. How can I prevent further atrophy?
   Maintain tongue mobility with regular exercises and treat underlying diseases promptly.

10. Does age alone cause it?
    Age‐related sarcopenia can contribute, but marked atrophy often signals a pathology.

11. Is physical therapy helpful?
    Yes—speech‐language pathologists provide targeted therapy for strength and coordination.

12. Can nutritional supplements help?
    Adequate protein and, in some cases, creatine or amino acids may support muscle health.

13. When should I get imaging?
    If the cause is unclear or a mass/lesion is suspected along the nerve pathway.

14. Is hypoglossal nerve damage common with surgery?
    It’s a rare complication in neck surgeries; awareness and careful technique minimize risk.

15. What is the prognosis?
    Depends on cause: disuse forms improve with therapy, while neurogenic atrophy often persists.

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 23, 2025.

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