Visual Attention toward Patients with Hemifacial Microsomia Reconstruction: A Prospective Eye-Tracking Study.

Abstract

Facial areas attracting the most visual attention in hemifacial microsomia (HFM) are poorly understood. Furthermore, it is not clear whether and how visual attention changes from before surgery to after surgery. This study characterized layperson visual attention to before and after reconstruction HFM using eye-tracking technology. Visual fixations (Tobii Pro Nano) were recorded in 4 areas of interest from 60 participants completing 2 consecutive trials of 68 total images in each hemiface of 17 patients with HFM before and after orthognathic jaw reconstruction. Linear mixed effect models evaluated whether visual fixations were affected by surgical reconstruction. 47,354 visual fixations were captured over 120 trials within defined areas of interest. Linear mixed effect models revealed significantly decreased postoperative visual fixations in the mandible and chin region [before reconstruction, 716 (54.8%); after reconstruction, 591 (45.2%); β = -0.198, SE = 0.056, z = -3.550, P < 0.001). Analysis also revealed significantly increased postoperative visual fixations in the forehead and orbit region (before reconstruction, 11,350 [48.6%]; after reconstruction, 12,000 [51.4%]; β = 0.086, SE = 0.015, z = 5.664, P < 0.00001). Following corrective jaw surgery for HFM, laypersons demonstrated significantly less visual attention to the mandible and chin and increased visual attention to the forehead and orbit. These findings suggest that postoperative improvement toward aesthetic normalcy may reduce visual attention to previously anomalous anatomy.