Transversus Linguae Muscle Diseases

Diseases of the transversus linguae muscle—one of the four intrinsic muscles of the tongue—can disrupt normal tongue shape and function, leading to difficulties in speech, swallowing, and taste perception.

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Anatomy of the Transversus Linguae Muscle

Structure and Location

The transversus linguae muscle consists of a thin, flat sheet of fibers that fan out from the mid-line of the tongue to its lateral margins. It lies deep to the superior longitudinal muscle and superficial to the vertical muscle, forming part of the intrinsic musculature that shapes the tongue NCBIWikipedia.

Origin

The fibers originate from the median fibrous septum, a central connective-tissue partition that divides the tongue into right and left halves Wikipedia.

Insertion

They pass laterally to insert into the submucosal fibrous tissue at the sides of the tongue, blending with other intrinsic muscle fibers IMAIOS.

Blood Supply

Blood is delivered primarily by branches of the lingual artery, itself a branch of the external carotid artery. The lingual artery courses deep to the hyoglossus muscle, sending off dorsal, sublingual, and deep lingual branches that perfuse the intrinsic muscles KenhubNCBI.

Nerve Supply

Innervation comes from the hypoglossal nerve (cranial nerve XII), which controls all intrinsic and most extrinsic tongue muscles, enabling precise shape changes WikipediaNCBI.

Functions

Contraction of the transversus linguae muscle:

1. Narrows the tongue body.

2. Elongates the tongue.

3. Shapes the tongue to form a midline groove for swallowing.

4. Assists in speech articulation, particularly consonant production.

5. Facilitates mastication by directing food onto molars.

6. Aids in deglutition (swallowing) by molding the bolus NCBI.

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Types of Transversus Linguae Muscle Disorders

1. Atrophy
   Progressive thinning and wasting of muscle fibers, often linked to nerve injury or systemic disease.

2. Hypertrophy
   Uncommon enlargement of transverse muscle fibers, leading to macroglossia and speech changes.

3. Paralysis (Hypoglossal Palsy)
   Loss of function due to hypoglossal nerve lesions, resulting in tongue deviation and weakness.

4. Fibrosis and Contracture
   Scar-tissue formation from trauma or chronic inflammation causes reduced flexibility.

5. Strain and Sprain
   Overstretching or microtears from excessive tongue movements, as in playing wind instruments.

6. Muscular Dystrophy
   Genetic disorders (e.g., myotonic dystrophy) affecting intrinsic tongue muscle integrity.

7. Myositis
   Inflammation of the tongue muscle from autoimmune or infectious causes.

8. Benign Tumors
   Hamartomas, rhabdomyomas, or neurofibromas arising within muscle tissue.

9. Malignant Tumors
   Rhabdomyosarcoma or low-grade sarcomas infiltrating the transversus linguae.

10. Traumatic Lacerations
    Cuts or punctures from accidents or surgical complications.

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Causes

1. Hypoglossal Nerve Injury
   Damage from surgery or trauma disrupts nerve signals to the transversus linguae.

2. Stroke
   Vascular insult in the hypoglossal nucleus or pathway leads to muscle dysfunction.

3. Amyotrophic Lateral Sclerosis (ALS)
   Progressive motor neuron degeneration causes tongue atrophy and paralysis.

4. Myasthenia Gravis
   Autoimmune blockade at the neuromuscular junction weakens tongue muscles.

5. Myotonic Dystrophy
   Genetic disorder leading to prolonged muscle contraction and eventual atrophy.

6. Infectious Myositis
   Viral (e.g., Coxsackie) or bacterial (e.g., staphylococcal) infection induces inflammation.

7. Radiation Therapy
   Scarring and reduced blood flow post-radiation in head and neck cancer patients.

8. Chemical Injury
   Acid or alkali burns from ingested substances damage muscle tissue.

9. Chronic Inflammation
   Conditions like lichen planus extend into muscle layers, causing fibrosis.

10. Trauma
    Direct blows or falls cause contusion or laceration of the muscle.

11. Nutritional Deficiencies
    Lack of vitamin B12 or protein impairs muscle repair and maintenance.

12. Endocrine Disorders
    Hypothyroidism can cause macroglossia and muscle edema.

13. Neuropathy
    Diabetes-related nerve damage alters muscle control.

14. Autoimmune Disorders
    Lupus or scleroderma induce local muscle fibrosis.

15. Medication-Induced
    Statins or colchicine may rarely cause myopathy in tongue muscles.

16. Neoplasm Infiltration
    Local spread of head and neck cancers into the muscle.

17. Vascular Malformations
    Hemangiomas or lymphangiomas compromise muscle architecture.

18. Genetic Syndromes
    Beckwith-Wiedemann syndrome features congenital macroglossia.

19. Excessive Use
    Repetitive strain in professional wind-instrument players.

20. Idiopathic
    In many cases, no clear cause is ever identified.

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Symptoms

1. Tongue Weakness
   Difficulty holding food on the teeth or out of the mouth.

2. Asymmetry
   Deviation of the tongue toward the weaker side.

3. Speech Changes
   Slurring or altered articulation of consonants.

4. Dysphagia
   Trouble initiating swallowing or experiencing choking.

5. Pain or Discomfort
   Aching along the sides of the tongue, especially when moving.

6. Glossalgia
   Burning or stabbing sensations within the muscle.

7. Atrophy
   Visible thinning or concave deformation of the tongue.

8. Hypertrophy
   Unusually thick or firm tongue margins.

9. Fasciculations
   Fine twitching of tongue fibers visible under mucosa.

10. Stiffness
    Reduced flexibility when trying to widen or elongate the tongue.

11. Saliva Control Issues
    Drooling due to inability to shape the tongue properly.

12. Taste Alteration
    Blunted or distorted taste sensation from muscle fibrosis.

13. Sialorrhea
    Excess saliva pooling from impaired swallowing.

14. Ulceration
    Chronic friction against teeth causing sores.

15. Snoring or Sleep Apnea
    Tongue position changes narrow the airway.

16. Jaw Pain
    Compensation by masticatory muscles leads to temporomandibular discomfort.

17. Weight Loss
    Difficulty eating solid foods.

18. Fatigue
    Early muscle fatigue when speaking or eating.

19. Numbness
    If nerve involvement extends beyond motor fibers.

20. Headache
    Referred pain from muscle strain.

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Diagnostic Tests

1. Clinical Examination
   Observation of tongue shape, movement, and strength.

2. Electromyography (EMG)
   Measures electrical activity of the transversus linguae muscle.

3. Nerve Conduction Study
   Assesses hypoglossal nerve integrity.

4. Ultrasound Imaging
   Visualizes muscle thickness and texture in real time.

5. Magnetic Resonance Imaging (MRI)
   High-resolution images of muscle fibers and surrounding tissues.

6. Computed Tomography (CT)
   Detects calcifications or masses within the tongue.

7. Muscle Biopsy
   Histological analysis to identify myositis or dystrophy.

8. Blood Tests
   CK levels, autoimmune markers, and infectious serologies.

9. Genetic Testing
   For suspected muscular dystrophies or congenital syndromes.

10. Swallow Study (Videofluoroscopy)
    Evaluates bolus transit and tongue-base function.

11. Tongue Strength Measurement
    Using devices like the Iowa Oral Performance Instrument.

12. Electrodiagnostic Reporting
    Quantitative EMG analysis of muscle fiber recruitment.

13. Needle EMG
    Fine‐needle insertion to detect fibrillations.

14. Angiography
    For vascular malformations affecting the muscle.

15. PET-CT Scan
    Detects metabolic activity in suspected malignancies.

16. Intraoral Endoscopy
    Visual inspection for fibrosis or ulcerations.

17. Salivary Flow Measurement
    To assess secondary effects on saliva control.

18. Videostroboscopy
    Observes tongue movement during phonation.

19. Quantitative Sensory Testing
    If numbness coexists.

20. Laryngoscopy
    To rule out airway compromise from tongue enlargement.

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Non-Pharmacological Treatments

1. Speech Therapy
   Targeted exercises to improve articulation and tongue control.

2. Swallowing Rehabilitation
   Techniques to strengthen tongue base for safer deglutition.

3. Oral Motor Exercises
   Isometric holds and resistance training with tongue depressors.

4. Biofeedback
   Real-time EMG feedback guides precise muscle activation.

5. Physical Therapy
   Neck and jaw mobilizations to relieve compensatory strain.

6. Myofascial Release
   Manual therapy to reduce fibrosis tension.

7. Warm Compresses
   Increase local blood flow to ease stiffness.

8. Cryotherapy
   Short applications of cold to reduce inflammation.

9. Electrical Stimulation
   Neuromuscular electrical stimulation (NMES) to activate fibers.

10. Ultrasound Therapy
    Deep-tissue heating to promote healing.

11. Laser Therapy
    Low-level laser to modulate inflammation.

12. Acupuncture
    May reduce pain and improve muscle coordination.

13. Massage
    Gentle intraoral and extraoral massage to relieve tension.

14. Stretching Exercises
    Guided elongation of the tongue to prevent contracture.

15. Postural Training
    Optimize head and neck alignment to facilitate tongue function.

16. Diet Modification
    Soft or pureed foods when mastication is impaired.

17. Hydration Protocols
    Adequate fluids to ease swallowing.

18. Assistive Devices
    Tongue exercisers like IOPI for resistance training.

19. Voice Therapy
    Techniques to reduce compensatory vocal strain.

20. Yoga and Relaxation
    Reduce overall muscle tension affecting the tongue.

21. Mindfulness
    Stress reduction may alleviate bruxism-related tongue strain.

22. Heat-Moist Pack
    Combine warmth and moisture for comfort.

23. Guided Imagery
    Visualizing smooth tongue movements can retrain neuromuscular patterns.

24. Ergonomic Assessment
    For performers, optimize instrument-mouthpiece setup to avoid strain.

25. Proprioceptive Training
    Tapping or brushing the tongue to enhance sensory feedback.

26. Vestibular Exercises
    Improve balance if compensatory head positions are adopted.

27. CPAP Adjustment
    For sleep apnea with tongue enlargement, ensure proper mask fit.

28. Orthodontic Consultation
    Address malocclusion­-induced tongue trauma.

29. Occupational Therapy
    Integrate tongue exercises into daily tasks.

30. Education and Ergonomics
    Teach patients self-care strategies to avoid overuse.

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Drugs

1. Prednisone
   Systemic corticosteroid to reduce inflammatory myositis.

2. Methotrexate
   Disease-modifying agent for autoimmune tongue involvement.

3. Azathioprine
   Immunosuppressant in chronic inflammatory conditions.

4. Intravenous Immunoglobulin (IVIG)
   Modulates immune response in severe myositis.

5. Pyridostigmine
   Acetylcholinesterase inhibitor for myasthenia gravis–related weakness.

6. Colchicine
   May be used off-label for muscle inflammation.

7. Statins
   (When implicated in drug-induced myopathy, adjusting dose may help.)

8. Botulinum Toxin
   Local injections for focal dystonia or hypertrophy relief.

9. Cyclophosphamide
   In severe refractory autoimmune muscle disease.

10. Rituximab
    Monoclonal antibody for resistant inflammatory myopathies.

11. Azathioprine
    (Repeat for emphasis on long-term immunosuppression).

12. Mycophenolate Mofetil
    Steroid-sparing agent in chronic myositis.

13. Tacrolimus
    Topical or systemic calcineurin inhibitor in selected cases.

14. Penicillin
    For bacterial myositis when staphylococcal infection is confirmed.

15. Oseltamivir
    In viral myositis due to influenza.

16. Gabapentin
    Neuropathic pain adjunct for glossalgia.

17. NSAIDs
    Ibuprofen or naproxen for mild pain and inflammation.

18. Acetaminophen
    Analgesic for pain control when NSAIDs are contraindicated.

19. Bisphosphonates
    Investigational use in dystrophic muscle hypertrophy.

20. Vitamin B12 Supplementation
    When deficiency contributes to neuropathy and muscle wasting.

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Surgical Interventions

1. Muscle Biopsy
   Diagnostic and sometimes therapeutic removal of tissue.

2. Partial Resection
   For localized fibrotic bands restricting movement.

3. Debulking Surgery
   In hypertrophic or tumor-related macroglossia.

4. Laser Ablation
   Minimally invasive reduction of fibrotic tissue.

5. Cryoablation
   Freezing of localized tumor or fibrotic areas.

6. Microsurgical Nerve Repair
   Reanastomosis after hypoglossal nerve injury.

7. Neurotomy
   Selective nerve sectioning for focal dystonia.

8. Tumor Excision
   Removal of benign or malignant masses.

9. Genioglossus Advancement
   For sleep apnea with tongue base obstruction.

10. Tongue Suspension
    Suture techniques to reposition tongue and relieve airway compromise.

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Prevention Strategies

1. Proper Hydration
   Maintains tissue elasticity and reduces strain.

2. Balanced Diet
   Ensures adequate protein and micronutrients for muscle health.

3. Oral Hygiene
   Prevents chronic inflammation that can extend into muscle.

4. Avoidance of Chemical Irritants
   Reduces risk of chemical myositis.

5. Protective Gear
   Mouthguards in sports to prevent tongue trauma.

6. Responsible Medication Use
   Monitor drugs with known myopathic risk.

7. Post-Surgical Care
   Gentle tongue exercises after head and neck surgery.

8. Ergonomic Training
   For wind-instrument players to avoid overuse.

9. Regular Dental Check-Ups
   Prevent tooth edges from causing chronic tongue injury.

10. Prompt Infection Treatment
    Early antibiotics or antivirals to avoid myositis.

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When to See a Doctor

If you experience any persistent tongue weakness, pain, difficulty speaking or swallowing, or notice visible changes (such as asymmetry, atrophy, or hypertrophy) lasting more than two weeks, seek evaluation by a speech-language pathologist, otolaryngologist (ENT), or neurologist. Early diagnosis and intervention improve outcomes.

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Frequently Asked Questions

1. What is the main function of the transversus linguae muscle?

It narrows and elongates the tongue, essential for shaping the bolus during swallowing and forming certain speech sounds.

2. How is transversus linguae muscle atrophy diagnosed?

Via clinical exam, EMG, and imaging (MRI or ultrasound) to confirm reduced muscle bulk and function.

3. Can transversus linguae muscle disorders affect taste?

Yes—severe fibrosis or atrophy may distort tongue shape and impede contact with taste buds.

4. Is there a cure for myositis of the tongue?

Treatment focuses on controlling inflammation (steroids, immunosuppressants) and rehabilitating muscle function with therapy.

5. Are tongue exercises effective for recovery?

Absolutely—oral motor exercises and biofeedback can significantly improve strength and coordination.

6. What role does the hypoglossal nerve play?

It innervates the transversus linguae muscle; injury causes paralysis or weakness.

7. Can medication cause tongue muscle problems?

Yes—statins, colchicine, and certain chemotherapy agents may induce myopathy in rare cases.

8. How long does recovery take after transversus linguae injury?

It varies: nerve injuries may need months for regeneration, while mild strains can heal in weeks.

9. Do I need surgery for tongue fibrosis?

Surgery is reserved for severe cases where non-surgical therapies fail to restore functional movement.

10. What exercises help with tongue paralysis?

Resistance training with devices (e.g., tongue depressor presses) and guided stretching improve strength.

11. Can focal dystonia affect the transversus linguae muscle?

Yes—idiopathic focal dystonia can cause involuntary contractions and abnormal tongue posture.

12. Is botulinum toxin safe for tongue muscle dystonia?

When injected by an experienced clinician, it can reduce involuntary contractions with minimal side effects.

13. How do I prevent tongue trauma during sports?

Use a properly fitted mouthguard and avoid risky behaviors that could injure the tongue.

14. Can nutrition impact tongue muscle health?

Deficiencies in protein, B12, and other micronutrients impair muscle repair and function.

15. When should I consider a muscle biopsy?

If non-invasive tests are inconclusive and a definitive histological diagnosis is needed for myositis or dystrophy.

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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