Visual Perceptions Of Hemifacial Microsomia Reconstruction: A Prospective Study With Eye Tracking Technology And Linear Mixed Effects Model Analysis
Dillan F. Villavisanis, BA1, Clifford I. Workman, PhD2, Zachary D. Zapatero, BS1, Giap H. Vu, MD1, Jessica D. Blum, MSc1, Liana Cheung, MBBS1, Daniel Y. Cho, MD PhD1, Jordan W. Swanson, MD MSc1, Scott P. Bartlett, MD1, Anjan Chatterjee, MD2, Jesse A. Taylor, MD1.
1Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: Facial areas attracting visual attention in lateralizing craniofacial pathologies such as hemifacial microsomia (HFM) are poorly understood but are ideal for studying gaze patterns. This study aims to determine lay person visual attention of pre- and post- jaw reconstruction HFM patients using eye-tracking technology.
METHODS: Sixty-eight images of patients with pre- and post-jaw reconstruction were used in this study. Four discrete areas of interest (AOIs) were defined on the anomalous side as forehead/orbit (FO), cheek/ear (CE), nose/lip (NL), and mandible/chin (MC). The TobiiPro Nano eye-tracking system registered visual fixations, and linear mixed effect models (RStudio) compared visual fixations pre- and post-surgery.
RESULTS: 23,215 visual fixations were captured over 60 trials from 30 participants within defined AOIs. Analysis revealed significantly decreased postoperative visual fixations on MC [447 (55.4%) pre-reconstruction, 359 (44.6%) post reconstruction; β=-0.220, SE=0.071, z=-3.084, p=0.002] and CE [1380 (52.3%) pre-reconstruction, 1260 (47.7%) post-reconstruction; β=-0.090, SE=0.040, z=-2.22, p=0.026]. Analysis revealed significantly increased postoperative visual fixations in the FO [5855 (49.3%) pre-reconstruction, 6032 (50.7%) post-reconstruction; β=0.066, SE=0.021, z=3.096, p=0.002].
CONCLUSION: Following surgery to improve jaw form and function in HFM, laypersons demonstrated significantly less visual attention to CE and MC regions and increased visual attention to the FO region. These findings suggest postoperative improvement towards aesthetic normalcy may reduce visual attention to previously anomalous anatomy. 
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