Elaboração e validação de um protocolo para avaliação do insucesso cirúrgico em lactentes de 0 a 23 meses submetidos à cirurgia de frenectomia lingual

Abstract

Background: Ankyloglossia is a congenital condition of the tongue in which the lingual frenulum, a fibrous structure connecting the tongue to the floor of the mouth, restricts tongue mobility. In Brazil, the enactment of Law No. 13,002/2014 made the Lingual Frenulum Assessment Protocol for Infants mandatory in all hospitals and maternity units for newborns delivered in these institutions, resulting in a substantial increase in lingual frenectomy procedures. However, the literature highlights the absence of a standardized instrument to assess surgical failure in infants undergoing lingual frenectomy, representing an important gap in scientific knowledge. Objective: To develop and validate a protocol for assessing surgical failure in infants aged 0 to 23 months who underwent lingual frenectomy. Methods: This methodological, observational, cross-sectional, and quali-quantitative study aimed to develop and validate a protocol for assessing surgical failure following lingual frenectomy in infants aged 0 to 23 months. Initially, a scoping review was conducted to provide the scientific basis for the development of the protocol. The target population consisted of expert judges, including dentists and speech-language pathologists registered with their respective professional councils and directly involved in the care of infants undergoing lingual frenectomy. The Delphi technique was used to obtain consensus among geographically dispersed specialists. Eighteen experts were recruited using the snowball sampling technique. Responses were analyzed according to the level of agreement among specialists using the Content Validity Index (CVI). Data were analyzed using the IBM Statistical Package for the Social Sciences (SPSS®), version 21. Results: The scoping review systematically mapped the main clinical aspects associated with surgical failure following lingual frenectomy in infants aged 0 to 23 months. By synthesizing studies published in three languages up to 2024, recurrent evidence patterns and knowledge gaps related to the standardization of postoperative failure criteria were identified. The main clinical characteristics associated with surgical failure included persistent bleeding, local hematoma, injury to the floor of the mouth structures or salivary ducts, ulceration, as well as unplanned return visits and the need for additional interventions. These findings supported the development of an assessment instrument designed to assist in the identification of surgical failure and therapeutic decision-making. The resulting protocol comprises nine sections addressing the clinical aspects associated with surgical failure after lingual frenectomy. Conclusion: The protocol developed represents an innovative approach to standardizing the clinical assessment of surgical failure following lingual frenectomy in children aged 0 to 23 months. It provides an instrument with the potential to improve postoperative follow-up, reduce variability in clinical assessments, support clinical decision-making, strengthen interdisciplinary practice, and enhance methodological standardization in future research.