Transverse Muscle of the Tongue Disorders

Transverse muscle of the tongue disorders encompass any pathological condition affecting the transversus linguae—one of the four intrinsic tongue muscles—leading to altered tongue shape, mobility, strength, or sensation. The transversus linguae arises from the median fibrous septum and inserts into the lateral margins of the tongue; its primary action is to narrow and elongate the tongue during speech and swallowing. Disorders of this muscle may be congenital (e.g., ankyloglossia), inflammatory (e.g., myositis), neurogenic (e.g., hypoglossal nerve injury), neoplastic (e.g., tumor infiltration), traumatic, or degenerative (e.g., age‐related sarcopenia). Clinical consequences range from mild articulation changes to severe dysphagia and dysarthria. WikipediaRadiopaedia

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Anatomy of the Transverse Muscle of the Tongue

Structure & Location

The transverse muscle is one of four intrinsic muscles of the tongue, confined entirely within its substance. Fibers run horizontally from the median fibrous septum toward the lateral edges, interdigitating with the vertical muscle to form the bulk of the tongue’s core. Wikipedia

Origin

– Median fibrous septum (the midsagittal connective tissue partition of the tongue) Wikipedia

Insertion

– Submucosal fibrous tissue along the lateral margins of the tongue Wikipedia

Blood Supply

– Branches of the lingual artery (from the external carotid artery) perfuse the intrinsic muscles, including transversus linguae. Kenhub

Nerve Supply

– Motor innervation via the hypoglossal nerve (cranial nerve XII), which supplies all intrinsic muscles except palatoglossus. NCBIWikipedia

Functions

1. Narrowing the tongue body to create a more pointed shape.

2. Elongating the tongue, aiding extension during speech tasks.

3. Stabilizing the tongue midline during fine articulatory movements.

4. Shaping the tongue surface for precise swallowing and bolus control.

5. Assisting other intrinsic muscles in rapid adjustments of tongue contour.

6. Contributing to the formation of specific speech sounds (e.g., lateral consonants). Wikipedia

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Types of Transverse Muscle Disorders

Pathologic categories include:

1. Ankyloglossia (tongue-tie) – congenital short lingual septum restricting horizontal spread Wikipedia

2. Hypoglossal nerve palsy – denervation atrophy and deviation toward the affected side NCBI

3. Lingual dystonia – involuntary, task-specific contractions of intrinsic muscles PubMed

4. Myositis – inflammatory infiltration of tongue fibers (e.g., polymyositis) PMC

5. Muscular dystrophy – degenerative fiber loss in systemic dystrophies (e.g., Duchenne) BioMed Central

6. Traumatic laceration – direct injury to muscle fibers from oral trauma

7. Neoplastic infiltration – tumor invasion (squamous cell carcinoma) disrupting muscle architecture MDPI

8. Macroglossia – generalized tongue enlargement with relative fiber hypertrophy (e.g., Down syndrome) Frontiers

9. Radiation-induced fibrosis – post-radiotherapy scarring in head & neck cancer patients

10. Infectious myositis – bacterial (e.g., syphilitic gummas) or fungal (candidiasis) involvement BioMed Central

11. Botulism – toxin-mediated neuromuscular blockade of tongue fibers

12. Age-related sarcopenia – reduction in fiber size and force generation with aging PMC

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Causes

Key etiologies can be grouped into congenital, traumatic, infectious, neurogenic, inflammatory, neoplastic, toxic, and degenerative categories:

1. Ankyloglossia (tongue-tie) Wikipedia

2. Hypoglossal nerve injury (surgical or traumatic) NCBI

3. Focal oromandibular dystonia PubMed

4. Polymyositis or dermatomyositis PMC

5. Duchenne/Becker muscular dystrophy BioMed Central

6. Direct blade or bite trauma

7. Squamous cell carcinoma invasion MDPI

8. Down syndrome–associated macroglossia Frontiers

9. Radiation fibrosis after head & neck cancer

10. Syphilitic gumma formation BioMed Central

11. Candida albicans infection BioMed Central

12. Botulinum toxin exposure

13. Alcohol-related nutritional myopathy

14. Vitamin B12 or iron deficiency

15. Diabetes mellitus neuropathy

16. Amyotrophic lateral sclerosis involvement Physiology Journals

17. Sarcopenia of intrinsic muscles PMC

18. Chronic mouth-breathing–induced overload Wikipedia

19. Autoimmune connective tissue disease (e.g., scleroderma)

20. Idiopathic (unknown)

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Symptoms

Patients with transverse muscle disorders may report:

1. Difficulty narrowing the tongue for lateral sounds (/l/) Wikipedia

2. Impaired elongation for certain consonants (/th/) Wikipedia

3. Tongue deviation or asymmetry NCBI

4. Weakness or fatigue during prolonged speech

5. Dysarthria (slurred speech)

6. Dysphagia (difficulty swallowing)

7. Food pocketing along lateral sulci

8. Altered taste sensation (secondary)

9. Pain or tenderness in tongue body

10. Fasciculations (twitches) NCBI

11. Muscle stiffness or cramping

12. Tongue tremor (in dystonia) Wikipedia

13. Glossitis or mucosal changes

14. Ulceration in chronic inflammatory states

15. Macroglossia (visibly enlarged tongue) BioMed Central

16. Speech articulation errors (lisps) Wikipedia

17. Reduced tongue pressure (measurable by manometry)

18. Impaired bolus control in oral phase

19. Hypersalivation or drooling

20. Secondary jaw or facial pain

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Diagnostic Tests

1. Clinical examination of tongue shape & strength Wikipedia

2. Hypoglossal nerve assessment (neurological exam) NCBI

3. Electromyography (EMG) of intrinsic muscles

4. Nerve conduction study for CN XII function

5. MRI of tongue & floor of mouth Medscape

6. CT scan for bony or neoplastic changes

7. Ultrasound of tongue musculature

8. Muscle biopsy in suspected myositis or dystrophy

9. Serum creatine kinase (CK) levels for muscle damage

10. Autoantibody panels (ANA, myositis markers)

11. Swallowing study (videofluoroscopy)

12. Fiber-optic endoscopic evaluation of swallowing (FEES)

13. High-resolution manometry of tongue pressures

14. Surface EMG (sEMG) for dysphagia

15. Genetic testing for dystrophies

16. Videostroboscopy for speech tasks

17. Blood glucose, B12, iron studies

18. Microbiologic cultures in infectious cases

19. Biopsy for neoplastic infiltration

20. Lactate & metabolic panels in mitochondrial disease

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Non-Pharmacological Treatments

1. Speech therapy for articulation and strength training PMC

2. Swallowing exercises (e.g., Masako maneuver)

3. Isometric tongue presses against spatula

4. Tongue protrusion–retraction drills

5. Lateralization exercises for side-to-side movement

6. Tongue stretching techniques

7. Myofascial release massage of submucosa

8. Neuromuscular electrical stimulation (NMES)

9. Low-level laser therapy for inflammation

10. Ultrasound therapy to reduce fibrosis

11. Acupuncture for pain relief

12. Oral motor facilitation with resistance tools

13. Biofeedback using pressure sensors

14. Postural training for head and neck alignment

15. Breathing retraining to reduce mouth-breathing

16. Hydration & warm saline rinses for comfort

17. Thermal stimulation (cold/hot packs)

18. Relaxation techniques for dystonia triggers

19. Stress management & mindfulness Wikipedia

20. Dietary texture modification (soft diet)

21. Electromyographic biofeedback for swallowing

22. Oral sensory stimulation (tactile, thermal)

23. Manual lymphatic drainage for edema

24. Custom oral appliances to support tongue posture

25. Cricopharyngeal stretching (indirect)

26. Orofacial myofunctional therapy Wikipedia

27. Mirror feedback for movement correction

28. Task-specific practice (speech sounds)

29. Cognitive-behavioral therapy for pain perception

30. Environmental modifications (adaptive utensils)

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Pharmacological Treatments

1. Botulinum toxin type A injections for focal dystonia PubMed

2. Prednisone for inflammatory myositis

3. Methotrexate as a steroid-sparing agent

4. Azathioprine for autoimmune myositis

5. Intravenous immunoglobulin (IVIG)

6. NSAIDs (ibuprofen) for pain & inflammation

7. Acetaminophen for analgesia

8. Baclofen for muscle spasticity

9. Diazepam (benzodiazepine) for dystonia

10. Trihexyphenidyl (anticholinergic) in dystonia Wikipedia

11. Carbamazepine for neuralgia or neuropathic pain

12. Gabapentin for neuralgic discomfort

13. Levodopa in secondary parkinsonian syndromes

14. Dopamine antagonists (e.g., haloperidol)

15. Proton-pump inhibitors for reflux-induced irritation

16. Clonazepam for myokymia

17. Pentoxifylline to improve microcirculation

18. Vitamin B12 supplementation

19. Iron therapy for deficiency anemia

20. Antifungal agents (e.g., nystatin) in candidiasis

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Surgical Treatments

1. Frenotomy/frenuloplasty for ankyloglossia Wikipedia

2. Partial glossectomy for localized tumors

3. Free flap reconstruction post-tumor resection

4. Hypoglossal nerve repair/grafting in transection injuries

5. Selective myectomy in severe dystonia PubMed

6. Laser ablation of fibrotic bands

7. Coronal advancement flap for macroglossia

8. Tongue base reduction in obstructive sleep apnea

9. Anastomosis of ansa cervicalis to CN XII for reinnervation

10. Open surgical release of scar tissue in radiation fibrosis

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Prevention Strategies

1. Early screening for tongue-tie in newborns

2. Protective gear to prevent oral trauma

3. Prompt treatment of oral infections

4. Careful radiation planning to spare tongue tissue

5. Nutritional optimization (B12, iron)

6. Management of systemic diseases (diabetes, autoimmune)

7. Oral hygiene maintenance to reduce infection risk

8. Regular dental & ENT check-ups

9. Stress reduction to minimize dystonia triggers

10. Speech & myofunctional therapy at first sign of dysfunction

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When to See a Doctor

Consult a healthcare professional if you experience:

• Persistent tongue weakness or deviation interfering with speech.

• Swallowing difficulty (choking, coughing on liquids).

• Pain, ulceration, or unexplained swelling of the tongue.

• Speech changes lasting more than two weeks.

• Visible mass or induration within the tongue.

• New‐onset fasciculations or tremor.

• Feeding difficulties in infants (poor latch, weight loss). Wikipedia

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Frequently Asked Questions

1. What is the transverse muscle of the tongue?
   It’s an intrinsic muscle that runs horizontally from the median septum to the sides, narrowing and lengthening the tongue when it contracts. Wikipedia

2. How does ankyloglossia affect this muscle?
   A short septum prevents full horizontal spread, limiting tongue shape changes and causing feeding or speech issues. Wikipedia

3. Can hypoglossal nerve injury be reversed?
   Partial recovery may occur with nerve repair or grafting, but outcomes vary with injury severity. NCBI

4. What tests diagnose dystonia of the transverse muscle?
   Electromyography (EMG) and clinical assessment during speech tasks confirm involuntary contractions. PubMed

5. Are tongue exercises effective?
   Yes—targeted isometric and range-of-motion exercises can strengthen intrinsic muscles and improve function. PMC

6. When is surgery needed for tongue-tie?
   If feeding or speech problems persist despite therapy, a simple frenotomy often provides rapid relief. Wikipedia

7. What is tongue myositis?
   An inflammatory condition where immune cells attack muscle fibers, causing pain and weakness. PMC

8. How is lingual cancer treated?
   Early tumors may require partial glossectomy with reconstruction; advanced cases need multimodal therapy. MDPI

9. Can medication help my tongue cramps?
   Muscle relaxants (baclofen, diazepam) and anticholinergics can reduce spasm in dystonia. Wikipedia

10. Is macroglossia reversible?
    Depends on cause; surgical reduction may be needed for symptomatic Down syndrome cases. Frontiers

11. What role does nutrition play?
    Deficiencies in B12 or iron can weaken muscles; supplementation often improves strength. BioMed Central

12. How do I measure tongue strength?
    Devices like tongue pressure manometers gauge maximal isometric pressure against the palate.

13. Does radiation therapy damage tongue muscles?
    Yes—fibrosis can set in months after treatment, limiting mobility and shape changes.

14. Can Botox injections harm swallowing?
    Doses must be carefully tailored; over‐injection can weaken essential swallowing muscles. PubMed

15. Are there exercises for dystonic tongues?
    Sensory tricks (e.g., certain chewing patterns) and task-specific practice can help manage focal dystonia.

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

Last Updated: April 23, 2025.

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