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Tongue Transverse Muscle Dystonia

Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT) Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT)
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Rx Musculoskeletal System (A - Z)

Tongue transverse muscle dystonia is a rare form of lingual dystonia, a focal movement disorder in which the transverse intrinsic muscle of the tongue contracts involuntarily, either in sustained spasms or repetitive jerks. These contractions lead to narrowing and elongation of the tongue, causing difficulties with speaking, chewing, swallowing, and sometimes breathing. NCBIDystonia Foundation

Anatomy of the Transverse Muscle

  1. Structure & Location

    • The transverse muscle is one of four intrinsic muscles fully contained within the tongue.

    • It lies deep in the tongue, running horizontally from the middle septum out toward the sides. RadiopaediaWikipedia

  2. Origin & Insertion

    • Origin: Median fibrous (lingual) septum at the tongue’s midline.

    • Insertion: Submucous fibrous tissue along each lateral margin of the tongue. Wikipedia

  3. Blood Supply

    • Primarily from the lingual artery, a branch of the external carotid artery, via its sublingual and dorsal lingual branches. Kenhub

  4. Nerve Supply

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

  5. Functions
    The transverse muscle helps:

    • Narrow & elongate the tongue body.

    • Shape speech by forming grooves and ridges for certain sounds (e.g., “t,” “s,” “l”).

    • Guide food between the teeth during chewing.

    • Form the bolus and propel it backward to swallow.

    • Clean the mouth by pressing against teeth and cheeks.

    • Maintain tongue posture, adapting to sensory feedback. TeachMeAnatomyNCBI

Types of Lingual Dystonia

  1. Protrusion dystonia: Tongue involuntarily thrusts forward.

  2. Retraction dystonia: Tongue pulls backward into the mouth.

  3. Curling dystonia: Tongue curls or rolls inward/sideways.

  4. Task-specific dystonia: Triggered only during speaking or eating.

  5. Segmental dystonia: Extends to jaw and lower face muscles.

  6. Secondary dystonia: Caused by medications, lesions, or metabolic disorders. Frontiers

Causes

(Based on known risk factors for focal dystonias.) Frontiers

  1. Idiopathic (Primary): No identifiable cause.

  2. Genetic mutations: e.g., DYT1, DYT6 gene variants.

  3. Antipsychotic drugs: Neuroleptics leading to drug-induced dystonia.

  4. Antiemetic medications: Metoclopramide or prochlorperazine exposure.

  5. Stroke: Damage in basal ganglia or brainstem regions.

  6. Head trauma: Concussion or skull fractures.

  7. Brain tumors: Lesions affecting motor control pathways.

  8. Wilson’s disease: Copper accumulation in basal ganglia.

  9. Manganese toxicity: Occupational exposure in miners.

  10. Infections: Encephalitis or meningitis affecting motor centers.

  11. Autoimmune disorders: Lupus or paraneoplastic syndromes.

  12. Thyroid dysfunction: Hyperthyroidism-related metabolic changes.

  13. Hypoxia: Perinatal oxygen deprivation.

  14. Neurodegenerative diseases: Parkinson’s, Huntington’s.

  15. Psychogenic factors: Stress-induced muscle spasms.

  16. Metabolic imbalances: Hypoglycemia or electrolyte disturbances.

  17. Environmental toxins: Pesticide or solvent exposure.

  18. Drug withdrawal: Abrupt cessation of dopaminergic medications.

  19. Surgical complications: After brain or neck surgery.

  20. Radiation therapy: Damage from head/neck irradiation.

Symptoms

(Signs patients commonly experience.) Frontiers

  1. Involuntary tongue contractions: Sudden, forceful spasms.

  2. Abnormal tongue posture: Narrowed or elongated shape at rest.

  3. Speech difficulty (dysarthria): Slurred or strained voice.

  4. Chewing problems: Uneven bolus formation.

  5. Swallowing difficulty (dysphagia): Choking or coughing when eating.

  6. Pain or discomfort: Soreness from sustained muscle tension.

  7. Drooling: Poor saliva control.

  8. Tongue biting: Self-inflicted injuries during spasms.

  9. Fatigue: Tongue muscles tire quickly.

  10. Dry mouth: Reduced ability to clear saliva.

  11. Speech breaks: Voice stops mid-word.

  12. Social embarrassment: Avoidance of eating or speaking in public.

  13. Weight loss: From eating difficulties.

  14. Neck strain: Compensatory head movements.

  15. Breathing difficulty: In severe protrusion dystonia.

  16. Anxiety: Worry about unpredictable spasms.

  17. Depression: Due to chronic disability.

  18. Task specificity: Symptoms only during certain actions.

  19. Spread to jaw muscles: Tightness or tremor in masticatory muscles.

  20. Sleep relief: Symptoms often lessen during sleep.

Diagnostic Tests

(To confirm diagnosis and rule out other causes.) NCBI

  1. Clinical neurological exam: Observing posture and movement.

  2. Electromyography (EMG): Records muscle activity during spasms.

  3. MRI of brain: Identifies structural lesions.

  4. CT scan: Detects bone or calcification anomalies.

  5. Genetic testing: Screens for dystonia-related mutations.

  6. DAT-SPECT scan: Evaluates dopamine transporter levels.

  7. Video fluoroscopic swallow study: Assesses swallowing mechanics.

  8. Flexible laryngoscopy: Visualizes tongue and throat motion.

  9. Blood copper & ceruloplasmin: For Wilson’s disease.

  10. Thyroid function tests: TSH, T3, T4 levels.

  11. Electrolyte panel: Sodium, potassium, calcium.

  12. Liver function tests: Rule out hepatic causes.

  13. Autoimmune panel: ANA, anti-dsDNA.

  14. EEG: To exclude seizure disorders.

  15. PET scan: Metabolic activity in basal ganglia.

  16. Psychiatric evaluation: Assess for psychogenic dystonia.

  17. Speech-language pathology assessment: Detail speech impairment.

  18. Otolaryngology exam: Structural lesions in oropharynx.

  19. Video-EEG: If spasms resemble seizures.

  20. Trial of sensory tricks (“geste antagoniste”): Temporary relief confirms dystonia.

Non-Pharmacological Treatments

(First-line and adjunct therapies.) Frontiers

  1. Speech therapy: Exercises to improve articulation.

  2. Oral motor training: Strengthening intrinsic muscles.

  3. Sensory tricks: Light touch to chin or cheek to reduce spasms.

  4. Biofeedback: Visual/auditory feedback to modulate muscle activity.

  5. Physical therapy: Neck and facial muscle relaxation.

  6. Massage therapy: Gentle tongue and jaw massage.

  7. Acupuncture: May lessen muscle overactivity.

  8. Transcutaneous electrical nerve stimulation (TENS): Sensory modulation.

  9. Transcranial magnetic stimulation (rTMS): Modulates cortical excitability.

  10. Deep brain stimulation (DBS) trial programming: Non-surgical trial.

  11. Behavioral therapy: Techniques to manage anxiety-induced spasms.

  12. Yoga and mindfulness: Stress reduction.

  13. Tai Chi: Gentle movement for motor control.

  14. Relaxation breathing: Lowers muscle tone.

  15. Mirror therapy: Visual feedback to re-train movement.

  16. Thermal therapy: Warm compresses to relax muscles.

  17. Cold application: Brief relief of acute spasms.

  18. Habit reversal training: Replace dystonic posture with neutral one.

  19. Tactile stimulation: Textured oral inserts to alter feedback.

  20. Oral appliances: Splints to reposition jaw/tongue.

  21. Swallowing maneuvers: Compensatory techniques in dysphagia.

  22. Nutritional counseling: Soft diet planning.

  23. Occupational therapy: Adaptive strategies for eating.

  24. Cognitive behavioral therapy (CBT): For coping with chronic disease.

  25. Group support: Peer counseling.

  26. Hypnotherapy: Relaxation and muscle control.

  27. Ultrasound therapy: Deep tissue relaxation.

  28. Low-level laser therapy: Experimental muscle modulation.

  29. Vestibular rehabilitation: For associated head-neck strain.

  30. Home exercise program: Daily tongue stretches and holds.

Drugs

(Medication options; many used off-label.) Frontiers

  1. Botulinum toxin A: Injected into tongue muscles to weaken spasms.

  2. Trihexyphenidyl: Anticholinergic to reduce muscle contractions.

  3. Benztropine: Another anticholinergic agent.

  4. Baclofen: GABA_B agonist muscle relaxant.

  5. Diazepam: Benzodiazepine for muscle relaxation.

  6. Clonazepam: Longer-acting benzodiazepine.

  7. Tetrabenazine: Depletes presynaptic dopamine.

  8. Risperidone: Low-dose atypical antipsychotic for refractory cases.

  9. Gabapentin: Modulates excitatory neurotransmission.

  10. Levodopa/Carbidopa: For dopamine-responsive dystonias.

  11. Pramipexole: Dopamine agonist.

  12. Piracetam: Nootropic with muscle-stabilizing properties.

  13. Zolpidem: Can transiently improve dystonia.

  14. Bromocriptine: Dopamine agonist.

  15. Amantadine: NMDA antagonist with some benefit.

  16. Trihexyphenidyl: High-potency anticholinergic.

  17. Propranolol: Beta-blocker for anxiety-related exacerbations.

  18. Tizanidine: α2-agonist muscle relaxant.

  19. Carbamazepine: Sodium-channel blocker anticonvulsant.

  20. Topiramate: GABAergic anticonvulsant.

Surgical Interventions

(Reserved for severe, refractory cases.) Frontiers

  1. Deep Brain Stimulation (GPi): Electrodes in internal globus pallidus.

  2. Pallidotomy: Lesioning part of globus pallidus to reduce overactivity.

  3. Thalamotomy: Targeting ventral oral nuclei.

  4. Selective peripheral denervation: Cutting overactive nerve branches to tongue.

  5. Myotomy: Surgical division of transverse muscle fibers.

  6. Glossectomy (partial): Removing part of tongue tissue.

  7. Hypoglossal nerve ablation: Reducing nerve input.

  8. Tongue-lunge genioglossus advancement: Repositioning muscle attachments.

  9. Nerve stimulator implant: Peripheral nerve stimulation.

  10. Radiofrequency ablation: Targeted to motor end plates.

Prevention Strategies

  1. Avoid dopamine-blocking drugs when possible.

  2. Monitor antipsychotic dosage carefully.

  3. Use the lowest effective dose of antiemetics.

  4. Protect head from injury with helmets or fall prevention.

  5. Manage metabolic disorders (e.g., Wilson’s, thyroid).

  6. Reduce environmental toxin exposure (e.g., manganese).

  7. Maintain good nutrition for neural health.

  8. Minimize chronic stress through relaxation techniques.

  9. Regular exercise for healthy basal ganglia function.

  10. Early treatment of infections affecting the brain.

When to See a Doctor

  • Persistent or worsening tongue spasms that interfere with daily activities.

  • Difficulty speaking or swallowing for more than a few days.

  • Rapid onset of abnormal tongue posture or pain.

  • Signs of self-injury (tongue biting or sores).

  • Weight loss or dehydration due to eating issues.

Frequently Asked Questions

  1. What is tongue transverse muscle dystonia?
    A focal movement disorder where the transverse intrinsic tongue muscle contracts involuntarily, narrowing and lengthening the tongue in spasms.

  2. How common is lingual dystonia?
    It’s rare, making up about 3–5% of all dystonias.

  3. What triggers tongue spasms?
    Speaking, chewing, stress, or certain medications often provoke spasms.

  4. Can stress worsen symptoms?
    Yes. Stress and anxiety can heighten muscle overactivity, making spasms more severe.

  5. Is there a cure?
    There’s no permanent cure, but treatments (botulinum toxin, therapy, DBS) can greatly improve symptoms.

  6. How is it diagnosed?
    Through clinical exam, EMG testing, and imaging (MRI/CT) to rule out other causes.

  7. What side effects can treatment have?
    Botulinum toxin may cause temporary weakness; medications can cause dry mouth, drowsiness, or movement side effects.

  8. Will it spread to other muscles?
    It can remain focal, but in some cases, dystonia may involve adjacent jaw or facial muscles.

  9. Can children get it?
    Most cases begin in middle age, but rare pediatric forms exist, often genetic.

  10. Are there surgical options?
    Yes—DBS, pallidotomy, or selective denervation for severe, medication-resistant cases.

  11. How often are injections needed?
    Botulinum toxin typically lasts 3–4 months before repeat injections are needed.

  12. Is it painful?
    Muscle contractions can be uncomfortable or painful, especially during prolonged spasms.

  13. Can it affect breathing?
    Severe protrusion dystonia can interfere with airway, requiring urgent care.

  14. Does diet help?
    A soft or blended diet can reduce chewing strain and ease swallowing.

  15. What support is available?
    Support groups, speech and occupational therapy, and counseling can help manage the physical and emotional impact.

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 24, 2025.

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