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I feel like I remember creatures with a rake-like ability (maybe called rake!) that allowed gore attacks. Are there any compelling reasons a creature couldn't have a rake ability or rake-like ability with something other than claws?
Format: rake (2 claws +8, 1d4+2); Location: Special Attacks.
Good for you, making and tweaking your own monsters!
The short answer: There's absolutely no reason it doesn't have anything you like.
The slightly longer answer: it's good form to adjust the damage or CR to reward the players according to the threat they face.
How it all happens is up to you. If you invent a special attack that works like rake, called syringe, no problem.
Syringe: when the doctor begins the round with a victim, sorry, patient grappled/ pinned/ whatever... a syringe appears in his previously empty hand and sticks them on the but-tocks.
Chug: when the Student begins the round with a tankard succesfully grappled, he immediately drains 1d10+con modifier tenths of a pint of beer. Treat results over 10 as 10.
Silly examples, but if you want...say...a carnivorous plant to sprout internal thorns and pierce grappled victims, or mouths to open in the fists of maulers, or belly hooks to start digging in, that's your right and privilege. Using existing rules as a guideline is just good sense, and let's players accept it quickly. After squealing.