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Losorelli S, Chang JK, Chang KW, Most SP, Truong MT. Gaze Patterns of Normal and Microtia Ears Pre- and Post-Reconstruction. Laryngoscope 2024; 134:3136-3142. [PMID: 38334225 DOI: 10.1002/lary.31331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To understand attentional preferences for normal and microtia ears. METHODS Eye-tracking technology was used to characterize gaze preferences. A total of 71 participants viewed images of 5 patients with unilateral microtia. Profile images of patient faces and isolated ears including normal, microtia, and post-reconstruction microtia ears were shown. Total time of fixation in predefined areas of interest (AOI) was measured. Inferential statistics were used to assess significance of fixation differences between AOIs within and between facial or auricular features. RESULTS The ear received most visual attention in lateral view of the face (1.91 s, 1.66-2.16 s) [mean, 95% CI], followed by features of the "central triangle"-the eyes (1.26 s, 1.06-1.46), nose (0.48 s, 0.38-0.58), and mouth (0.15 s, 0.15-0.20). In frontal view, microtia ears received less attention following surgical reconstruction (0.74 s vs. 0.4 s, p < 0.001). The concha was the most attended feature for both normal (2.97 s, 2.7-3.23) and reconstructed microtia ears (1.87 s, 1.61-2.13). Scars on reconstructed ears altered the typical visual scanpath. CONCLUSION The ear is an attentional gaze landmark of the face. Attention to microtia ears, both pre- and post-reconstruction, differs from gaze patterns of normal ears. The concha was the most attended to subunit of the ear. Attentional gaze may provide an unbiased method to determine what is important in reconstructive surgery. LEVEL OF EVIDENCE NA Laryngoscope, 134:3136-3142, 2024.
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Affiliation(s)
- Steven Losorelli
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Julia K Chang
- California University of Science and Medicine, Colton, California, U.S.A
| | - Kay W Chang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Sam P Most
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Mai Thy Truong
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Romein EJ, Groot ALW, Remmers JS, Lissenberg B, Moll AC, Saeed P, Hartong DT. Determining Asymmetry Thresholds in Anophthalmia/Microphthalmia Using a Three-dimensional Animated Model. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00419. [PMID: 38934734 DOI: 10.1097/iop.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE Congenital microphthalmia and anophthalmia are rare development disorders with underdevelopment of the orbital region, resulting in asymmetry of the face. No clear guidelines exist to determine when these deviations are acceptable. METHODS The face of a healthy 6-year-old child was three-dimensionally scanned. On this scan, we modeled various incremental degrees of facial asymmetries using three-dimensional modeling software. We modeled for smaller palpebral fissures, sunken eyes, and downward displacement of the eye. We also tested whether adjusting the vertical palpebral fissure height in relation to the horizontal palpebral fissure width affected perception. A total of 22 videos were created in which the model turned the head horizontally and vertically. We created a questionnaire asking raters how acceptable the face is, on a linear scale from 0 to 10. RESULTS Results showed a correlation between the degree of asymmetry and the acceptability score of the raters. Enophthalmos of ≥6 mm, palpebral fissure width ≤79% compared with the other eye, and 2 mm or more downward displacement of the eye resulted in a significant different acceptability score. The desire for correction was strongly increased when these thresholds were exceeded. Adjusting the vertical palpebral fissure height to the horizontal palpebral fissure width resulted in a worse acceptability score. CONCLUSION A unilateral sunken eye (enophthalmos) of 6 mm or more, asymmetric horizontal palpebral fissure length of ≤79%, and a lower position of one eye of more than 2 mm resulted in unacceptable judgment. These data can be used to evaluate treatment outcome in children treated for congenital microphthalmia and anophthalmia.
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Affiliation(s)
- Emiel J Romein
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
| | - Annabel L W Groot
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
| | - Jelmer S Remmers
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
| | - Birgit Lissenberg
- Department Epidemiology and Data Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, de Amsterdam, Netherlands
| | - Annette C Moll
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peerooz Saeed
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
| | - Dyonne T Hartong
- Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam Orbital Center, Amsterdam, Netherlands
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Armstrong MF, Orbelo DM, Wallerius KP, Lebechi CA, Lohse CM, Dey JK, Bayan SL. Visual Gaze Patterns in the Analysis of Glottic Lesions: Does Experience Increase Diagnostic Accuracy? Ann Otol Rhinol Laryngol 2024; 133:22-29. [PMID: 37365768 DOI: 10.1177/00034894231179519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate visual gaze patterns and the ability to correctly identify cancer among participants of different experience levels when viewing benign and malignant vocal cord lesions. METHODS Thirty-one participants were divided into groups based on level of experience. These included novice (medical students, PGY1-2 otolaryngology residents), intermediate (PGY3-5 otolaryngology residents, gastroenterology fellow), advanced practice providers (physician assistants, nurse practitioners, and speech language pathologists), and experts (board-certified otolaryngologists). Each participant was shown 7 images of vocal cord pathology including glottic cancer, infectious laryngitis, and granuloma and asked to determine the likelihood of cancer on a scale of certain, probable, possible, and unlikely. Eye tracking data were collected and used to identify the area of interest (AOI) that each participant fixated on first, fixated on the longest, and had the greatest number of fixations. RESULTS No significant differences were seen among groups when comparing AOI with first fixation, AOI with longest fixation, or AOI with most fixations. Novices were significantly more likely to rate a low likelihood of cancer when viewing infectious laryngitis compared to more experienced groups (P < .001). There was no difference in likelihood of cancer rating among groups for the remaining images. CONCLUSIONS There was no significant difference in gaze targets among participants of different experience levels evaluating vocal cord pathology. Symmetric appearance of vocal cord lesions may explain differences seen in likelihood of cancer rating among groups. Future studies with larger sample sizes will better elucidate gaze targets that lead to accurate diagnosis of vocal cord pathology.
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Affiliation(s)
- Michael F Armstrong
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Diana M Orbelo
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Chiamaka A Lebechi
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Semirra L Bayan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Boonipat T, Hebel NSD, Shapiro D, Stotland MA. Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5038. [PMID: 37731729 PMCID: PMC10508498 DOI: 10.1097/gox.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/09/2023] [Indexed: 09/22/2023]
Abstract
Background This study considers observers' reflexive responses to the rejuvenated face, and how instinctive responses relate to subjective judgment. We investigated observers' reflexive perception of faces both pre and post surgical intervention during the early stages of visual processing. Subjective character attribution for all test images was also assessed by the same observers. Method Forty frontal facial images of 20 patients portraying the pre- and postoperative high superficial musculoaponeurotic system facelift along with variable concomitant procedures were studied. Nineteen lookzone regions were mapped post hoc onto each image. Forty observers examined the images, whereas an eye-tracking camera recorded their eye movements. Visual fixation data were recorded and analyzed. Observers also rated each image on the basis of five elemental positive character attributes. Results A statistically coherent but nonsignificant (P > 0.05) trend was identified with the surgical intervention resulting in greater attention being paid to the central triangle region of the face with reduction in attention to the facial periphery. Facial rejuvenation significantly increased the subjective character ratings of all five positively valenced attributes tested. Average age estimate of the photos decreased significantly from 54 to 48.6 years (true average age of 57.4 years). Conclusions We provide data illustrating both reflexive and subjective responses to facial rejuvenation. Observers reported a more favorable impression of the treated faces and evaluated them as being younger than their true age. A trend was detected for increased visual fixation of the central facial region following rejuvenation. Interpretation of these findings and indication for further research is provided.
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Affiliation(s)
- Thanapoom Boonipat
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | | | - Daniel Shapiro
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Mitchell A. Stotland
- Department of Surgery, Weill-Cornell Medical College- Doha, Qatar
- Division of Plastic, Craniofacial, and Hand Surgery, Sidra Medicine, Doha, Qatar
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Hayajneh A, Shaqfeh M, Serpedin E, Stotland MA. Unsupervised anomaly appraisal of cleft faces using a StyleGAN2-based model adaptation technique. PLoS One 2023; 18:e0288228. [PMID: 37535557 PMCID: PMC10399833 DOI: 10.1371/journal.pone.0288228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
A novel machine learning framework that is able to consistently detect, localize, and measure the severity of human congenital cleft lip anomalies is introduced. The ultimate goal is to fill an important clinical void: to provide an objective and clinically feasible method of gauging baseline facial deformity and the change obtained through reconstructive surgical intervention. The proposed method first employs the StyleGAN2 generative adversarial network with model adaptation to produce a normalized transformation of 125 faces, and then uses a pixel-wise subtraction approach to assess the difference between all baseline images and their normalized counterparts (a proxy for severity of deformity). The pipeline of the proposed framework consists of the following steps: image preprocessing, face normalization, color transformation, heat-map generation, morphological erosion, and abnormality scoring. Heatmaps that finely discern anatomic anomalies visually corroborate the generated scores. The proposed framework is validated through computer simulations as well as by comparison of machine-generated versus human ratings of facial images. The anomaly scores yielded by the proposed computer model correlate closely with human ratings, with a calculated Pearson's r score of 0.89. The proposed pixel-wise measurement technique is shown to more closely mirror human ratings of cleft faces than two other existing, state-of-the-art image quality metrics (Learned Perceptual Image Patch Similarity and Structural Similarity Index). The proposed model may represent a new standard for objective, automated, and real-time clinical measurement of faces affected by congenital cleft deformity.
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Affiliation(s)
- Abdullah Hayajneh
- Electrical and Computer Engineering Department, Texas A&M University, College Station, TX, United States of America
| | - Mohammad Shaqfeh
- Electrical and Computer Engineering Program, Texas A&M University, Doha, Qatar
| | - Erchin Serpedin
- Electrical and Computer Engineering Department, Texas A&M University, College Station, TX, United States of America
| | - Mitchell A Stotland
- Division of Plastic, Craniofacial and Hand Surgery, Sidra Medicine, and Weill Cornell Medical College, Doha, Qatar
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Forked Paramedian forehead flap combined with nasolabial flap for pre-radiation coverage of exposed maxilla in the Total Rhinectomy patient. Am J Otolaryngol 2023; 44:103825. [PMID: 36898217 DOI: 10.1016/j.amjoto.2023.103825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Total rhinectomy is ontologically necessary for large and locally invasive carcinomas of the nasal cavity owing to the complex three-dimensional structure of the nose. Reconstruction options include singular or combined options of local tissue rearrangement, free flap reconstruction, and prosthetic reconstruction which may be delayed in the setting of post-ablative radiation therapy. If significant bony exposure is present prior to radiation, there is a substantial risk of osteoradionecrosis and the ensuing sequalae. In these cases, coverage of the bony defect may be advantageous prior to radiation and final reconstructive treatment. We present a case of a total rhinectomy defect for squamous cell carcinoma in a patient who had significant bony exposure prior to radiation which was resurfaced with a combined forked paramedian flap and nasolabial flap. The patient went on to be treated with a full course of radiation and had planned for a post-treatment nasal prosthesis.
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Parents of Children with Cleft Lip Exhibit Heightened Visual Attention to the Perioral Area. Plast Reconstr Surg Glob Open 2023; 11:e4790. [PMID: 36798720 PMCID: PMC9925101 DOI: 10.1097/gox.0000000000004790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/28/2022] [Indexed: 02/16/2023]
Abstract
Following high-quality surgical repair, children born with a cleft lip anomaly may still display lasting visual differences. We exposed control adults and parents of affected children to images of children with cleft deformity and compared their visual tracking patterns. The protocol investigated whether parental exposure to secondary cleft deformity heightens or diminishes visual attraction to this type of structural facial variation. Method Twenty participants (10 control adults, 10 parents of affected children) assessed 40 colored images of children's faces while their eye movements were tracked. Twenty-four control images and 16 repaired cleft lip images were displayed to observers. Nine bilateral facial aesthetic zones were considered as regions of interest. Percentage of time visually fixating within each region, and statistical differences in fixation duration percentage between the two participant groups and across the bilateral regions of interest were analyzed. Results While both groups of observers directed more visual attention to the nasal and oral regions of the cleft images than control images, parents of children with cleft lip spent significantly more time fixating on these areas (25% and 24% of the time, respectively) than did unaffected adults (14.6% and 19.3%; P < 0.001). Conclusions These results demonstrate that parents of cleft lip children exhibit heightened attention to this type of facial difference relative to the naive observer. These findings highlight that observer profile can meaningfully influence the perception of a facial deformity. Awareness of this information may enhance communication between surgeon and parents of an affected child by providing added insight into parental perspective.
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Bassiri-Tehrani B. Commentary on: How We Look at Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:123-124. [PMID: 36163301 DOI: 10.1093/asj/sjac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/07/2023] Open
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Basmacı F, Mersin TÖ, Turgut B, Akbulut K, Kılıçarslan MA. Perception of orbital epitheses evaluated with eye tracker. J Prosthodont 2022; 31:754-760. [PMID: 35909303 DOI: 10.1111/jopr.13578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Orbital epitheses replace a missing eyeball and surrounding soft tissue. Perception of epithesis in public gaze and the attention areas on the face are of interest. This study aimed to examine the differences in perception of orbital epitheses by prosthodontists, dentistry students, and laypeople with an objective evaluation tool that utilized eye-tracking technology. MATERIALS AND METHODS Twenty-four frontal facial images of 12 patients who had orbital epitheses were viewed by 81 observers (prosthodontists, dentistry students, laypeople) in random order for 5 seconds each. Gaze data were analyzed. Kruskal-Wallis H test with Bonferroni correction was used to compare parameters in groups and areas of interest. RESULTS First fixation duration at the mouth for symmetrical images were 0.30, 0.28, and 0.25 seconds for prosthodontists, students, and laypeople, respectively. Fixation duration at the mouth for the laypeople (0.27 second) was shorter than students (0.29 second) and prosthodontists (0.31 second) at symmetrical images. Time to the first fixation to epithesis, nose, and eye was significantly lower than the forehead and mouth for all groups. Fixation count at epithesis was 6.36 for prosthodontists, 5.64 for students, and 5.34 for laypeople. CONCLUSION Eyes were of most significant interest for all observer groups in symmetrical images. Individuals dealing with dentistry, especially prosthodontists, paid more attention to the mouth region along with the eyes in symmetrical images, considering fixation duration and fixation count. Attention directed to epithesis by all groups was verified with objective and measurable criteria. Prosthodontists' attention to epithesis and mouth was evident considering the four parameters measured.
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Affiliation(s)
- Fulya Basmacı
- Department of Prosthodontics, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Tuggen Özcivelek Mersin
- Department of Prosthodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | - Berna Turgut
- Department of Prosthodontics, Ankara Memorial Hospital, Ankara, Turkey
| | - Kuddusi Akbulut
- Department of Prosthodontics, Cappadocia University, Nevsehir, Turkey
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10
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Raggio BS, Adamson PA. Global Perspectives on Beauty. Facial Plast Surg Clin North Am 2022. [DOI: 10.1016/j.fsc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Gupta N, White H, Trott S, Spiegel JH. Observer Gaze Patterns of Patient Photographs Before and After Facial Feminization. Aesthet Surg J 2022; 42:725-732. [PMID: 34994379 DOI: 10.1093/asj/sjab434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human interaction begins with visual evaluation of others, and this often centers on the face. Objective measurement of this evaluation gives clues to social perception. OBJECTIVES The objective of this study was to use eye-tracking technology to evaluate if there are scanpath differences when observers view faces of cisgender men, cisgender women, and transgender women before and after facial feminization surgery (FFS) including when assigning tasks assessing femininity, attractiveness, and likability. METHODS Undergraduate psychology students were prospectively recruited as observers at a single institution. Their eye movements were recorded by eye-tracking technology when they were presented with frontal photographs of prototypical male, prototypical female, and pre- and post-FFS faces in a random order and then with prompting to assess femininity, attractiveness, and likability. RESULTS Twenty-seven observers performed the tasks. Participants focused their attention more on the central triangle of post-FFS and prototypical female images and on the forehead of pre-FFS and prototypical male images. Higher femininity ratings were associated with longer proportional fixations to the central triangle and lower proportional fixations to the forehead. CONCLUSIONS This preliminary study implies the scanpath for viewing a post-FFS face is closer to that for viewing a prototypical female than a prototypical male based on differences viewing the forehead and brow vs the central triangle.
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Affiliation(s)
- Nikita Gupta
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky , Lexington, KY , USA
| | - Hannah White
- Department of Psychological Sciences, University of Missouri-St. Louis , St. Louis, MO , USA
| | - Skylar Trott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky , Lexington, KY , USA
| | - Jeffrey H Spiegel
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine , Boston, MA , USA
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oPublic and patients’ perceptions of facial reanimation using lengthening temporalis myoplasty. J Plast Reconstr Aesthet Surg 2022; 75:3782-3788. [DOI: 10.1016/j.bjps.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/11/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
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13
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Laterality in modern medicine: a historical overview of animal laterality, human laterality, and current influences in clinical practice. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ryan JF, Ishii LE, Dey JK, Boahene KD, Byrne PJ, Ishii M. Visual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery. Facial Plast Surg Aesthet Med 2022; 24:436-442. [DOI: 10.1089/fpsam.2021.0361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John F. Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa E. Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacob K. Dey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kofi D.O. Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Shao K, Zullo SW, Fix W, Taylor L, Zhang J, Miller CJ, Etzkorn JR, Shin TM, Giordano CN, Higgins WH, Sobanko JF. Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers. Dermatol Surg 2022; 48:418-422. [PMID: 35165219 DOI: 10.1097/dss.0000000000003405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. OBJECTIVE To identify differences in perceived scar outcomes by different stakeholders. METHODS AND MATERIALS Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. RESULTS At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). CONCLUSION Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.
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Affiliation(s)
- Kimberly Shao
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Shannon W Zullo
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - William Fix
- Division of Dermatology, Albert Einstein College of Medicine, New York, New York
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junqian Zhang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William H Higgins
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Look me in the eyes! A pre-registered eye-tracking study investigating visual attention and affective reactions to faces with a visible difference. Body Image 2022; 40:67-77. [PMID: 34864605 DOI: 10.1016/j.bodyim.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
This research aims to determine how disfigurement alters visual attention paid to faces and to examine whether such a potential modified pattern of visual attention to faces with visible difference was associated, in turn, with perceiver's stigmatizing affective reactions. A pilot study (N = 38) and a pre-registered experimental eye-tracking study (N = 89) were conducted. First, the visual explorations of faces with and without disfigurement were compared. The association of these visual explorations with affective reactions were investigated next. Findings suggest that disfigurement impacts visual attention toward faces; attention is not merely attracted to the disfigured area but it is also diverted particularly from the eye area. Disfigurement also eases disgust-related, surprise-related, anxiety-related, and, to a lesser extent, hostility-related affective states. Exploratory interaction effects between attention to the eyes and to the disfigured part of the face revealed a hybrid effect on disgust-related affect and an increase in surprise-related affect when participants fixated more upon the disfigured area and fixated less upon the eyes. Thus, perceiver's attention is captured by disfigurement and also diverted from face internal features which seems to play a role in the affective reactions elicited.
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Pouwels S, Sanfilippo S, Owen E, Ingels KJAO, De Jongh FW, Blondeel P, Monstrey SJ. Measuring outcomes in facial palsy treatment: adding extra dimensions to a complex matter. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Boutsen L, Pearson NA, Jüttner M. Do facially disfiguring features influence attention and perception of faces? Evidence from an antisaccade task. Q J Exp Psychol (Hove) 2021; 75:830-840. [PMID: 34388951 PMCID: PMC8958561 DOI: 10.1177/17470218211041621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Facial disfigurements can influence how observers attend to and interact with the person, leading to disease-avoidance behaviour and emotions (disgust, threat, fear for contagion). However, it is unclear whether this behaviour is reflected in the effect of the facial stigma on attention and perceptual encoding of facial information. We addressed this question by measuring, in a mixed antisaccade task, observers' speed and accuracy of orienting of visual attention towards or away from peripherally presented upright and inverted unfamiliar faces that had either a realistic looking disease-signalling feature (a skin discolouration), a non-disease-signalling control feature, or no added feature. The presence of a disfiguring or control feature did not influence the orienting of attention (in terms of saccadic latency) towards upright faces, suggesting that avoidance responses towards facial stigma do not occur during covert attention. However, disfiguring and control features significantly reduced the effect of face inversion on saccadic latency, thus suggesting an impact on the holistic processing of facial information. The implications of these findings for the encoding and appraisal of facial disfigurements are discussed.
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Affiliation(s)
- Luc Boutsen
- School of Psychology, Aston University, Birmingham, UK
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19
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de Jongh FW, Sanches EE, Luijmes R, Pouwels S, Ramnarain D, Beurskens CHG, Monstrey SJ, Marres HAM, Ingels KJAO. Cosmetic appreciation and emotional processing in patients with a peripheral facial palsy: A systematic review. Neuropsychologia 2021; 158:107894. [PMID: 34022186 DOI: 10.1016/j.neuropsychologia.2021.107894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
Background; The goal of this review is 1) to summarize the studies assessing PFP by casual observers, patients themselves and the cosmetic appreciation of the PFP and 2) to summarize the studies assessing whether there is a difference in emotional recognition/processing of facial emotions and/or cognitive tasks in patients with a PFP. Materials and Methods; A multi-database systematic literature search was performed using the following databases: Pubmed, Embase, Medline, and The Cochrane Library from the earliest date of each database up to December 2019. Population of interest consisted of patients with a PFP and studies that investigated cosmetic appreciation and/or emotional recognition and/or emotional processing in these patients. Two authors rated the methodological quality of the included studies independently using the 'Newcastle - Ottawa Quality Assessment Scale' for nonrandomised studies' (NOS). Two authors extracted the outcome data regarding cosmetic appreciation and/or emotional recognition/processing from the included studies. Results; Twelve hundred and thirty-two studies were found of which eleven studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author RL and SP) was 0.68. Two studies investigated emotional processing and/or emotional recognition. Nine studies investigated cosmetic appreciation in both patients and casual observers. Important findings of this systematic review are that there is a correlation between the perceived severity of the PFP of the patients and the ratings by casual observers. Secondly there seems to be a laterality difference in cosmetic appreciation and thirdly there might to be a decreased emotional recognition and processing in patients with a PFP. Conclusion; Emotional recognition and cosmetic appreciation in patients with a PFP is an under investigated area, in which further studies are needed to substantiate the findings in current literature.
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Affiliation(s)
- Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Robin Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, the Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Carien H G Beurskens
- Department of Orthopedics, Section Physical Therapy, Radboudumc, Nijmegen, the Netherlands
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, the Netherlands
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20
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Boyaci O, Serpedin E, Stotland MA. Personalized quantification of facial normality: a machine learning approach. Sci Rep 2020; 10:21375. [PMID: 33288815 PMCID: PMC7721909 DOI: 10.1038/s41598-020-78180-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
What is a normal face? A fundamental task for the facial reconstructive surgeon is to answer that question as it pertains to any given individual. Accordingly, it would be important to be able to place the facial appearance of a patient with congenital or acquired deformity numerically along their own continuum of normality, and to measure any surgical changes against such a personalized benchmark. This has not previously been possible. We have solved this problem by designing a computerized model that produces realistic, normalized versions of any given facial image, and objectively measures the perceptual distance between the raw and normalized facial image pair. The model is able to faithfully predict human scoring of facial normality. We believe this work represents a paradigm shift in the assessment of the human face, holding great promise for development as an objective tool for surgical planning, patient education, and as a means for clinical outcome measurement.
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Affiliation(s)
- Osman Boyaci
- Electrical and Computer Engineering Department, Texas A&M University, College Station, 77843, USA
| | - Erchin Serpedin
- Electrical and Computer Engineering Department, Texas A&M University, College Station, 77843, USA
| | - Mitchell A Stotland
- Division of Plastic and Craniofacial Surgery, Department of Surgery, Sidra Medicine, C1-121 OPC, Doha, 26999, Qatar.
- Department of Surgery, Weill Cornell Medical College-Qatar, Doha, 26999, Qatar.
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21
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Frautschi RS, Dawlagala N, Klingemier EW, England HS, Sinclair NR, Zins JE. The Use of Eye Tracking Technology in Aesthetic Surgery: Analyzing Changes in Facial Attention Following Surgery. Aesthet Surg J 2020; 40:1269-1279. [PMID: 31956904 DOI: 10.1093/asj/sjaa008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ability to quantitatively analyze how we look at a face and determine if this changes following facial surgery should be of interest to the plastic surgeon. Eye tracking technology (ETT) provides the ability to record where observers fixate when viewing a facial image, enabling quantitative data to be obtained comparing pre- and postoperative changes. OBJECTIVES The authors sought to investigate ETT as a novel outcome assessment tool, determining if facial rejuvenation surgery shifts attention away from the prominent signs of aging, and if so, where this attention shifts. METHODS Twenty-five volunteers viewed 32 randomized frontal, oblique, and lateral images of 11 patients pre- and post-facelift. An eye movement monitoring system recorded the observer's eye position, net dwell time, fixation count, fixation time, and revisits into predefined areas of interest. Data were grouped and analyzed by angle and areas of interest. Paired t tests were employed to detect significant differences in pre- and post-images. RESULTS On frontal images, less dwell time, fixations, and revisits were noted on the bottom third, forehead, perioral region, and neck (P < 0.05). On the lateral view, less visual attention was given to the neck, upper third, and perioral region, with more time in the cheek, nose, and middle third (P < 0.05). On oblique images, less attention was given to the neck and upper lid with more aimed at the middle third of the face (P < 0.05). CONCLUSIONS ETT provides quantitative data post-facial rejuvenation. Facial aesthetic surgery does alter where observers look when viewing a face, decreasing the time spent inspecting the prominent signs of aging.
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Affiliation(s)
| | | | | | | | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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22
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Allen MA, Lucas JP, Chung M, Rayess HM, Zuliani G. Nasal Analysis of Classic Animated Movie Villains versus Hero Counterparts. Facial Plast Surg 2020; 37:348-353. [PMID: 32942313 DOI: 10.1055/s-0040-1716885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Opposing facial features between animated villains and heroes have historically been used to demonstrate contrasting morality between characters, and this could have an impact on how humans view someone as good or evil in everyday life. Studies have been done investigating classic dermatologic features of villainous characters. This principle can be applied to nasal features as well. A search for "top animated characters" was performed. Characters were chosen from American Film Institute's "The Top Tens," Rolling Stone's "25 Best Pixar Movie Characters," and Screenrant's "The 30 Best Animated Movie Characters of All Time." Twenty villains and twenty hero counterparts from respective films were chosen. Classic nasal features were analyzed. Twenty villains (14 male, 6 female) and 20 heroes (12 male, 8 female) were analyzed. Sixteen villains (80%) had greater than normal nasal frontal angle versus 18 heroes (90%). Thirteen villains (65%) had an acute nasolabial angle versus two heroes (10%). Two villains (10%) had excess columellar show versus seven heroes (35%). Seven villains (35%) and one hero (5%) had a dorsal hump. Twelve villains (60%) had an overprojected chin versus three heroes (15%). Villains in pre-2000s films more frequently had a dorsal hump, overprojected chin, ptotic tip, pollybeak deformity, and bulbous tip. Heroes in pre-2000s films more frequently had an overrotated tip. Villains and heroes commonly have a greater than normal nasofrontal angle. Villains more commonly have an acute nasolabial angle, underrotated tip, overprojected chin, dorsal hump, and pollybeak deformity. Heroes more commonly have a large nasolabial angle and overrotated tip. Further research in conjunction with psychologists is required to obtain concrete data on how this affects whether an individual in real life is seen as good or evil, and the impact this has on interactions in society, including in the medical field.
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Affiliation(s)
- Meredith A Allen
- Department of Otolaryngology, Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jordyn P Lucas
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael Chung
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Hani M Rayess
- Department of Otolaryngology, University of Tennessee, Memphis, Tennessee
| | - Giancarlo Zuliani
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,Department of Otolaryngology - Head and Neck Surgery, Zuliani Facial Aesthetics, Bloomfield Hills, Michigan
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23
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Asaad M, Dey JK, Al-Mouakeh A, Manjouna MB, Nashed MA, Rajesh A, Boonipat T, Bite U. Eye-Tracking Technology in Plastic and Reconstructive Surgery: A Systematic Review. Aesthet Surg J 2020; 40:1022-1034. [PMID: 32010929 DOI: 10.1093/asj/sjz328] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The use of eye-tracking technology in plastic surgery has gained popularity over the past decade due to its ability to assess observers' visual preferences in an objective manner. OBJECTIVES The goal of this study was to provide a comprehensive review of eye-tracking studies in plastic and reconstructive surgery, which can aid in the design and conduct of high-quality eye-tracking studies. METHODS Through application of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of articles published on eye-tracking across several databases was conducted from January 1946 to January 2019. Inclusion criteria included studies evaluating the use of eye-tracking technology in the field of plastic and reconstructive surgery. The resulting publications were screened by 2 independent reviewers. RESULTS A total of 595 articles were identified, 23 of which met our inclusion criteria. The most common application of eye-tracking was to assess individuals with cleft lip/palate (9 studies). All 19 studies that evaluated fixation patterns among conditions vs controls reported significant differences between the 2 groups. Five out of 7 studies assessing visual data between preoperative and postoperative patients identified significant differences between the preoperative and postoperative groups, whereas 2 studies did not. Nine studies examined the relation between severity indices, attractiveness scores, or personality ratings and gaze patterns. Correlation was found in 7 out of the 9 studies. CONCLUSIONS This systematic review demonstrates the utility of eye-tracking technology as a quantifiable objective assessment and emerging research tool for evaluating outcomes in several domains of plastic and reconstructive surgery.
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Affiliation(s)
- Malke Asaad
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
| | - Jacob K Dey
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Uldis Bite
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN
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24
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Anderies BJ, Dey JK, Gruszczynski NR, Price DL, Moore EJ, Janus JR. Dermal Fat Grafting to Reconstruct the Parotidectomy Defect Normalizes Facial Attention. Laryngoscope 2020; 131:E124-E131. [PMID: 32658339 DOI: 10.1002/lary.28890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Use validated eye-tracking technology to objectively measure 1) the attentional distraction of facial contour defects after superficial and total parotidectomy and 2) changes in attentional distraction with abdominal dermal fat graft reconstruction. METHODS Standardized frontal and oblique facial images of 16 patients who had undergone superficial or total parotidectomy with or without fat graft reconstruction; four normal controls were obtained. One hundred casual observers were recruited to view these images, and gaze data were collected using a Tobii Pro eye-tracking system. Gaze durations for predefined facial areas of interest were analyzed using mixed-effects linear regression to test study hypotheses. RESULTS For frontal images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (92 milliseconds, 95% confidence interval [CI]: 48-138 milliseconds, P < .001). Fat grafting normalized the attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .414). For oblique images, total parotidectomy increased gaze to the operated parotid area compared to the contralateral nonoperated parotid area (658 milliseconds, 95% CI: 463-854 milliseconds, P < .001). Fat grafting normalized this attentional distraction, with no difference in gaze time on the operated parotid region compared to normal control faces (P = .504). In both views, superficial parotidectomy demonstrated no significant attentional distractions, with or without fat grafting. CONCLUSIONS This eye-tracking study objectively demonstrates that total parotidectomy results in a facial contour deformity that is distracting to observers, whereas superficial parotidectomy does not. For total parotidectomy, this attentional distraction can be normalized with dermal fat graft reconstruction. LEVEL OF EVIDENCE 3b Laryngoscope, 131:E124-E131, 2021.
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Affiliation(s)
- Barrett J Anderies
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nelson R Gruszczynski
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey R Janus
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
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25
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A closer look at the paralyzed face; a narrative review of the neurobiological basis for functional and aesthetic appreciation between patients with a left and a right peripheral facial palsy. J Plast Reconstr Aesthet Surg 2020; 73:1434-1441. [PMID: 32507705 DOI: 10.1016/j.bjps.2020.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The facial nerve or n. facialis (NVII) is the seventh cranial nerve and it is responsible for the innervation of the mimic muscles, the gustatory organ, and the secretomotor function to the salivary, lacrimal, nasal and palatine glands. Clinical presentation of Facial Palsy (FP) is characterized by unilateral facial asymmetry and may present with a change in taste, decreased saliva production, and dysarthria. A facial palsy has a notable effect on the facial appreciation by both the patient and the environment and also affects quality of life and emotional processing. There appear to be differences in the appreciation of people with a left and right facial palsy. PURPOSE OF THIS REVIEW The purpose of the review is to give an overview of the anatomy of the facial nerve, neuro-anatomy of face processing, and hemispheric specialization and lateralization. Further,an overview is given of the clinical studies that translated the neuro-anatomical and neurobiological basis of these concepts into clinical studies. What this review adds: This review emphasizes the neurobiological evidence of differences in face processing between the left and right cerebral hemisphere, wherein it seems that the right hemisphere is superior in emotional processing. Several theories are proposed; 1) a familiarity hypothesis and 2) a left-right hemispheric specialization hypothesis. In clinical studies, promising evidence might indicate that, in patients with FP, there is indeed a difference in how left and right FP are perceived. This might give differences in decreased quality of life and finally in occurrence of depression. Further research must aim to substantiate these findings and determine the need for altering the standard therapeutic advice given to patients.
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26
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Dey JK, Ishii LE, Boahene KDO, Byrne PJ, Ishii M. Measuring Outcomes of Mohs Defect Reconstruction Using Eye-Tracking Technology. JAMA FACIAL PLAST SU 2020; 21:518-525. [PMID: 31670742 DOI: 10.1001/jamafacial.2019.1072] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Objectively measuring how Mohs defect reconstruction changes casual observer attention has important implications for patients and facial plastic surgeons. Objective To use eye-tracking technology to objectively measure the ability of Mohs facial defect reconstruction to normalize facial attention. Design, Setting, and Participants This observational outcomes study was conducted at an academic tertiary referral center from January to June 2016. An eye-tracking system was used to record how 82 casual observers directed attention to photographs of 32 patients with Mohs facial defects of varying sizes and locations before and after reconstruction as well as 16 control faces with no facial defects. Statistical analysis was performed from November 2018 to January 2019. Main Outcomes and Measures First, the attentional distraction caused by facial defects was quantified in milliseconds of gaze time using eye tracking. Second, the eye-tracking data were analyzed using mixed-effects linear regression to assess the association of facial defect reconstruction with normalized facial attention. Results The 82 casual observers (63 women and 19 men; mean [SD] age, 34 [12] years) viewed control faces in a similar and consistent fashion, with most attention (65%; 95% CI, 62%-69%) directed at the central triangle, which includes the eyes, nose, and mouth. The eyes were the most visually important feature, capturing a mean of 60% (95% CI, 57%-64%) of fixation time within the central triangle and 39% (95% CI, 36%-43%) of total observer attention. The presence of Mohs defects was associated with statistically significant alterations in this pattern of normal facial attention. The larger the defect and the more centrally a defect was located, the more attentional distraction was observed, as measured by increased attention on the defect and decreased attention on the eyes, ranging from 729 (95% CI, 526-931) milliseconds for small peripheral defects to 3693 (95% CI, 3490-3896) milliseconds for large central defects. Reconstructive surgery was associated with improved gaze deviations for all faces and with normalized attention directed to the eyes for all faces except for those with large central defects. Conclusions and Relevance Mohs defects are associated with altered facial perception, diverting attention from valuable features such as the eyes. Reconstructive surgery was associated with normalized attentional distraction for many patients with cutaneous Mohs defects. These data are important to patients who want to know how reconstructive surgery could change the way people look at their face. The data also point to the possibility of outcomes prediction based on facial defect size and location before reconstruction. Eye tracking is a valuable research tool for outcomes assessment that lays the foundation for understanding how reconstructive surgery may change perception and normalize facial deformity.
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Affiliation(s)
- Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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27
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Faris C, Heiser A, Quatela O, Jackson M, Tessler O, Jowett N, Lee LN. Health utility of rhinectomy, surgical nasal reconstruction, and prosthetic rehabilitation. Laryngoscope 2019; 130:1674-1679. [PMID: 31846094 DOI: 10.1002/lary.28480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/04/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Advanced nasal malignancies may require rhinectomy, which can have profound psychosocial impacts. Rhinectomy defects can be rehabilitated through surgery or prosthetics. We seek to understand the health utility of the rhinectomy defect, surgical, and prosthetic reconstruction, which have not been previously studied. STUDY DESIGN Prospective clinical study METHODS: Adult naïve observers (n = 273) ranked the utility of five randomized health states (monocular blindness, binocular blindness, post-rhinectomy nasal defect, postsurgical reconstruction, and post-prosthetic rehabilitation). Health utilities were measured using visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO). One-way analysis of variance (ANOVA) with post hoc Scheffe's test and the independent samples T-test for a priori comparisons were performed. Multiple linear regression was performed using participant demographics as independent predictors of utility scores. RESULTS Health utilities (VAS, SG, TTO) were reported as follows (mean ± SD): monocular blindness (0.71 ± 0.21, 0.84 ± 0.20, 0.85 ± 0.19), binocular blindness (0.48 ± 0.25, 0.68 ± 0.28, 0.63 ± 0.28), post-rhinectomy nasal defect (0.59 ± 0.24, 0.74 ± 0.24, 0.74 ± 0.24), postsurgical reconstruction (0.88 ± 0.16, 0.90 ± 0.18, 0.89 ± 0.13), and post-prosthetic rehabilitation (0.67 ± 0.22, 0.80 ± 0.23, 0.82 ± 0.20). Both surgical reconstruction (P < .001) and prosthetic rehabilitation (P < .001) significantly improved health utility. SG and TTO utility scores were inversely associated with observer age (P < .001) and participants who identified themselves as non-Caucasians (P < .05) in post-rhinectomy nasal defect, post-nasal surgical reconstruction, and post-nasal prosthetic rehabilitation health states, while higher levels of education were directly associated with SG scores (P < .05), respectively. CONCLUSION This is the first study to demonstrate the significant negative impact of the rhinectomy nasal defect on health utility. Rehabilitation by surgical or prosthetic techniques significantly increases health utility as rated by naïve observers. Laryngoscope, 130:1674-1679, 2020.
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Affiliation(s)
- Callum Faris
- Department of Otolaryngology, University of Antwerp Medical Center, Antwerp, Belgium, U.S.A
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Olivia Quatela
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matthew Jackson
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | - Nate Jowett
- Department of Otolaryngology, University of Antwerp Medical Center, Antwerp, Belgium, U.S.A
| | - Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Zhang J, Miller CJ, O'Malley V, Bowman EB, Etzkorn JR, Shin TM, Sobanko JF. Patient and Physician Assessment of Surgical Scars: A Systematic Review. JAMA FACIAL PLAST SU 2019; 20:314-323. [PMID: 29392275 DOI: 10.1001/jamafacial.2017.2314] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery. Objective To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians. Evidence Review A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines. Findings The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief. Conclusions and Relevance Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.
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Affiliation(s)
- Junqian Zhang
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | | | - Eric B Bowman
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia
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29
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Juarez MC, Ishii L, Nellis JC, Bater K, Huynh PP, Fung N, Darrach H, Russell JO, Ishii M. Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking. Laryngoscope 2019; 129:2789-2794. [DOI: 10.1002/lary.27933] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Jason C. Nellis
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Kristin Bater
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | | | - Nicholas Fung
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Halley Darrach
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Jonathon O. Russell
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Masaru Ishii
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
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Boutsen L, Pearson NA, Jüttner M. Differential impact of disfiguring facial features on overt and covert attention. Acta Psychol (Amst) 2018; 190:122-134. [PMID: 30103152 DOI: 10.1016/j.actpsy.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022] Open
Abstract
Observers can form negative impressions about faces that contain disfiguring features (e.g., scars). Previous research suggests that this might be due to the ability of disfiguring features to capture attention - as evidenced by contrasting observers' responses to faces with or without disfiguring features. This, however, confounds the effects of salience and perceptual interpretation, i.e. whether the feature is seen as integral to the face, or separate from it. Furthermore, it remains unclear to what extent disfiguring features influence covert as well as overt attention. We addressed these issues by studying attentional effects by photographs of unfamiliar faces containing a unilateral disfigurement (a skin discoloration) or a visually similar control feature that was partly occluding the face. Disfiguring and occluding features were first matched for salience (Experiment 1). Experiments 2 and 3 assessed the effect of these features on covert attention in two cueing tasks involving discrimination of a (validly or invalidly cued) target in the presence of, respectively, a peripheral or central distractor face. In both conditions, disfigured and occluded faces did not differ significantly in their impact on response-time costs following invalid cues. In Experiment 4 we compared overt attention to these faces by analysing patterns of eye fixations during an attractiveness rating task. Critically, faces with disfiguring features attracted more fixations on the eyes and incurred a higher number of recurrent fixations compared to faces with salience-matched occluding features. Together, these results suggest a differential impact of disfiguring facial features on overt and covert attention, which is mediated both by the visual salience of such features and by their perceptual interpretation.
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Liao D, Ishii M, Darrach HM, Bater KL, Smith J, Joseph AW, Douglas RS, Joseph SS, Ishii LE. Objectively Measuring Observer Attention in Severe Thyroid-Associated Orbitopathy: A 3D Study. Laryngoscope 2018; 129:1250-1254. [PMID: 30151919 DOI: 10.1002/lary.27447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/23/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Measure the attentional distraction of facial deformity related to severe thyroid-associated orbitopathy using three-dimensional (3D) images and eye-tracking technology. METHODS Observers recruited at an academic tertiary referral center viewed 3D facial images of patients with severe thyroid-associated orbitopathy (TAO) and controls without TAO. An infrared eye-tracking monitor recorded their eye movements and fixations in real time. Multivariate Hotelling's analysis, followed by planned posthypothesis testing, was used to compare fixation durations for predefined regions of interest, including the eyes, nose, mouth, central triangle, and remaining face without the central triangle between severe TAO patients and controls. RESULTS One hundred sixteen observers (mean age 26.4 years, 51% female) successfully completed the eye-tracking experiment. The majority of their attention was directed toward the central triangle (eyes, nose, mouth). On multivariate analysis, there were significant differences in the distribution of attention between control and severe TAO faces (T2 = 49.37; F(5,922) = 9.8314, P < 0.0001). On planned posthypothesis testing, observers attended significantly more to the eyes (0.77 seconds, P < 0.0001, 95% confidence interval [CI], 0.51, 1.03 seconds) and less to the nose (-0.42 seconds, P < 0.0001, 95% CI, -0.23, -0.62 seconds) in severe TAO patients. There was no significant difference in time spent on the mouth, the total time spent on the central triangle, or time spent in the remaining face between the two groups. CONCLUSION Severe TAO distracted observer attention toward the eyes compared to control patients. These data lend insight into how TAO may alter observers' perceptions of these patients. Future studies should investigate how these changes in observer gaze patterns may reflect the social perception of TAO patients. LEVEL OF EVIDENCE NA Laryngoscope, 129:1250-1254, 2019.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin L Bater
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Smith
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Andrew W Joseph
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raymond S Douglas
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Morzycki A, Wong A, Hong P, Bezuhly M. Assessing Attentional Bias in Secondary Cleft Lip Deformities: An Eye-Tracking Study. Cleft Palate Craniofac J 2018; 56:257-264. [PMID: 29742362 DOI: 10.1177/1055665618775728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Using a well-established measure of attention, we aimed to objectively identify differences in severity between types of simulated secondary cleft lip deformities. DESIGN Volunteer participants viewed a series of images of a child digitally modified to simulate different secondary unilateral cleft lip deformities (long lip, short lip, white roll/vermilion disjunction, and vermilion excess), a lip scar with no secondary deformity, or a normal lip. Eye movements were recorded using a table-mounted eye-tracking device. Dwell times for 7 facial regions (eyes, nose, mouth, left ear, right ear, scar, and entire face) were compared. PARTICIPANTS Forty-six naive adults (25 male; mean age 25.5 years) were recruited from our local university community. MAIN OUTCOME The primary outcome of the study was cumulative dwell time between facial regions (eyes, nose, mouth, left ear, right ear, scar, and entire face). RESULTS Participants spent significantly more time focused on the upper lip regions in patients with simulated secondary deformities relative to those who did not ( P < .01). Severe short lip deformities resulted in longer fixation times than severe long lips ( P < .05). Participants spent less time focused on the eye region in the presence of a secondary lip deformity ( P < .05). When total facial fixation time was assessed, short lip deformities resulted in the greatest duration dwell time ( P < .001). CONCLUSIONS This study presents objective data to support the concept that observers show varying degrees of attentional bias to the lip region depending on the type and severity of the simulated secondary cleft lip deformity.
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Affiliation(s)
- Alexander Morzycki
- 1 Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Wong
- 2 Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Hong
- 3 Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada.,4 Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- 2 Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,4 Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
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Wallace ER, Collett BR, Heike CL, Werler MM, Speltz ML. Behavioral-Social Adjustment of Adolescents with Craniofacial Microsomia. Cleft Palate Craniofac J 2018; 55:664-675. [PMID: 29356621 DOI: 10.1177/1055665617750488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective was to assess differences in psychosocial adjustment between adolescents with and without craniofacial microsomia (CFM). DESIGN This is a case-control follow-up study in adolescents with and without CFM. SETTING Participants were originally recruited as infants from 26 cities across the United States and Canada. PARTICIPANTS Participants included 142 adolescents with CFM (cases) and 316 peers without CFM (controls), their caregivers, and their teachers. MAIN OUTCOME MEASURES Social and behavior measures from the Achenbach System of Empirically Based Assessments (ASEBA), the PedsQL: Core Version, and the Children's Communication Checklist-2nd edition (CCC-2) were used. Linear regression was used to estimate case-control differences and corresponding standardized effect sizes (ES) and 95% confidence intervals after adjustment for sociodemographic confounds. We also examined case-control differences by facial phenotype and hearing status. RESULTS The magnitude and direction of case-control differences varied across assessment and respondent, but were generally modest (ES = -0.4 to 0.02, P values ranged from .003 to .85). There was little evidence for variation in case-control differences across different facial phenotypes or as a function of hearing status. CONCLUSIONS Our results suggest that in spite of multiple risk factors, adolescents with CFM exhibit behavior problems no more frequently than their peers without CFM. Future studies of individuals with CFM should focus on resilience and social coping mechanisms, in addition to maladjustment.
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Affiliation(s)
- Erin R Wallace
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
- 2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
- 3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 4 Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA
- 5 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Matthew L Speltz
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
- 2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
- 3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Johnson EK, Fields HW, Beck FM, Firestone AR, Rosenstiel SF. Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking. Am J Orthod Dentofacial Orthop 2017; 151:297-310. [PMID: 28153159 DOI: 10.1016/j.ajodo.2016.06.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Previous eye-tracking research has demonstrated that laypersons view the range of dental attractiveness levels differently depending on facial attractiveness levels. How the borderline levels of dental attractiveness are viewed has not been evaluated in the context of facial attractiveness and compared with those with near-ideal esthetics or those in definite need of orthodontic treatment according to the Aesthetic Component of the Index of Orthodontic Treatment Need scale. Our objective was to determine the level of viewers' visual attention in its treatment need categories levels 3 to 7 for persons considered "attractive," "average," or "unattractive." METHODS Facial images of persons at 3 facial attractiveness levels were combined with 5 levels of dental attractiveness (dentitions representing Aesthetic Component of the Index of Orthodontic Treatment Need levels 3-7) using imaging software to form 15 composite images. Each image was viewed twice by 66 lay participants using eye tracking. Both the fixation density (number of fixations per facial area) and the fixation duration (length of time for each facial area) were quantified for each image viewed. Repeated-measures analysis of variance was used to determine how fixation density and duration varied among the 6 facial interest areas (chin, ear, eye, mouth, nose, and other). RESULTS Viewers demonstrated excellent to good reliability among the 6 interest areas (intraviewer reliability, 0.70-0.96; interviewer reliability, 0.56-0.93). Between Aesthetic Component of the Index of Orthodontic Treatment Need levels 3 and 7, viewers of all facial attractiveness levels showed an increase in attention to the mouth. However, only with the attractive models were significant differences in fixation density and duration found between borderline levels with female viewers. Female viewers paid attention to different areas of the face than did male viewers. CONCLUSIONS The importance of dental attractiveness is amplified in facially attractive female models compared with average and unattractive female models between near-ideal and borderline-severe dentally unattractive levels.
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Affiliation(s)
| | - Henry W Fields
- Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio.
| | - F Michael Beck
- Division of Oral Biology, College of Dentistry, Ohio State University, Columbus, Ohio
| | - Allen R Firestone
- Division of Orthodontics, College of Dentistry, Ohio State University, Columbus, Ohio
| | - Stephen F Rosenstiel
- Division of Restorative and Prosthetic Dentistry, College of Dentistry, Ohio State University, Columbus, Ohio
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Southwick G. Invited Commentary on "A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure". Aesthetic Plast Surg 2017; 41:1360-1361. [PMID: 28779412 DOI: 10.1007/s00266-017-0950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Graeme Southwick
- Melbourne Institute of Plastic Surgery, Melbourne, Australia.
- Departments of Anatomy and Cell Biology, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
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Almeida A. Digital diagnosis of protruding ears. Acta Paediatr 2017; 106:1387-1388. [PMID: 28795498 DOI: 10.1111/apa.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ana Almeida
- GECAD, Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development, Institute of Engineering, Polytechnic of Porto; Porto Portugal
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Wang X, Cai B, Cao Y, Zhou C, Yang L, Liu R, Long X, Wang W, Gao D, Bao B. Objective method for evaluating orthodontic treatment from the lay perspective: An eye-tracking study. Am J Orthod Dentofacial Orthop 2017; 150:601-610. [PMID: 27692417 DOI: 10.1016/j.ajodo.2016.03.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Currently, few methods are available to measure orthodontic treatment need and treatment outcome from the lay perspective. The objective of this study was to explore the function of an eye-tracking method to evaluate orthodontic treatment need and treatment outcome from the lay perspective as a novel and objective way when compared with traditional assessments. METHODS The scanpaths of 88 laypersons observing the repose and smiling photographs of normal subjects and pretreatment and posttreatment malocclusion patients were recorded by an eye-tracking device. The total fixation time and the first fixation time on the areas of interest (eyes, nose, and mouth) for each group of faces were compared and analyzed using mixed-effects linear regression and a support vector machine. The aesthetic component of the Index of Orthodontic Treatment Need was used to categorize treatment need and outcome levels to determine the accuracy of the support vector machine in identifying these variables. RESULTS Significant deviations in the scanpaths of laypersons viewing pretreatment smiling faces were noted, with less fixation time (P <0.05) and later attention capture (P <0.05) on the eyes, and more fixation time (P <0.05) and earlier attention capture (P <0.05) on the mouth than for the scanpaths of laypersons viewing normal smiling subjects. The same results were obtained when comparing posttreatment smiling patients, with less fixation time (P <0.05) and later attention capture on the eyes (P <0.05), and more fixation time (P <0.05) and earlier attention capture on the mouth (P <0.05). The pretreatment repose faces exhibited an earlier attention capture on the mouth than did the normal subjects (P <0.05) and posttreatment patients (P <0.05). Linear support vector machine classification showed accuracies of 97.2% and 93.4% in distinguishing pretreatment patients from normal subjects (treatment need), and pretreatment patients from posttreatment patients (treatment outcome), respectively. CONCLUSIONS The eye-tracking device was able to objectively quantify the effect of malocclusion on facial perception and the impact of orthodontic treatment on malocclusion from the lay perspective. The support vector machine for classification of selected features achieved high accuracy of judging treatment need and treatment outcome. This approach may represent a new method for objectively evaluating orthodontic treatment need and treatment outcome from the perspective of laypersons.
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Affiliation(s)
- Xi Wang
- Postgraduate student, Orthodontic Department, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Bin Cai
- Chair, Orthodontic Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Yang Cao
- Professor, Orthodontic Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Chen Zhou
- Resident, Orthodontic Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Le Yang
- Postgraduate student, Maxillofacial Surgery Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Runzhong Liu
- Statistical consultant, Department of Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojing Long
- Assistant researcher, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Weicai Wang
- Resident, Orthodontic Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Dingguo Gao
- Professor, Psychology Department, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China.
| | - Baicheng Bao
- Resident, Orthodontic Department, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China.
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Luijmes RE, Beurskens CH, Pouwels S, Ingels KJ. A prospective cohort study assessing differences in cosmetic appreciation of lateralization while smiling in patients with a peripheral facial palsy. Laterality 2017; 23:381-390. [DOI: 10.1080/1357650x.2017.1320403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Robin E. Luijmes
- Department of Medical Psychology, Catharina Hospital, Eindhoven, Netherlands
| | - Carien H. G. Beurskens
- Department of Orthopedics, Section Physical Therapy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjaak Pouwels
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - Koen J. A. O. Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Jáuregui EJ, Tummala N, Seth R, Arron S, Neuhaus I, Yu S, Grekin R, Knott PD. Comparison of W-Plasty vs Traditional Straight-Line Techniques for Primary Paramedian Forehead Flap Donor Site Closure. JAMA FACIAL PLAST SU 2017; 18:258-62. [PMID: 27031499 DOI: 10.1001/jamafacial.2016.0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The paramedian forehead flap (PMFF) donor site scar is hard to disguise and may be a source of patient dissatisfaction. OBJECTIVE To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) closure techniques of the PMFF donor site. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at the University of California, San Francisco Medical Center. Clinical history and operative reports were reviewed for 31 patients who underwent a PMFF procedure performed between November 1, 2011, and May 29, 2014. Blinded photographic analysis of postoperative photographs was performed. INTERVENTIONS The pedicled component of the PMFF was raised primarily with either a W-plasty or traditional SL design. MAIN OUTCOMES AND MEASURES Standard photographs of the donor site, obtained at least 90 days after surgery, were reviewed and scored in a blinded fashion by 4 dermatologic surgeons using a 100-point visual analog scale (from 0 [worst possible outcome] to 100 [best possible outcome]) and a 5-point Likert scale (from very poor to excellent). Interrater reliability was assessed via Cronbach α testing. RESULTS All 31 forehead flaps survived during this study period; 16 PMFFs were raised with the W-plasty technique and 15 were raised with the SL technique. The W-plasty and SL groups were similar in terms of age, sex, and race/ethnicity (mean [SD] age, 68.4 [12.4] vs 61.8 [11.6] years; 13 [84%] vs 9 [60%] men; and 15 [94%] vs 13 [87%] white). Patients undergoing W-plasty closure had significantly higher mean visual analog scale scores compared with those undergoing SL closure (72.8 [18.3] vs 65.6 [18.1]; P = .03). Mean Likert scale scores for W-plasty were higher than those for SL closure, but the difference was not significant (3.77 [1.02] vs 3.43 [0.98]; P = .08). Overall interrater reliability for the visual analog scale and Likert scale scores were 0.67 and 0.58, respectively. CONCLUSIONS AND RELEVANCE Patients undergoing PMFF donor site closure using a primary W-plasty technique demonstrated better mean scar appearance of the forehead donor site compared with SL closure. The primary W-plasty technique did not result in any PMFF losses and should be considered for appropriate patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Emmanuel J Jáuregui
- Medical student, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Neelima Tummala
- Medical student, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco
| | - Rahul Seth
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center
| | - Sarah Arron
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Isaac Neuhaus
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Siegrid Yu
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Roy Grekin
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - P Daniel Knott
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center
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Wang TT, Wessels L, Hussain G, Merten S. Discriminative Thresholds in Facial Asymmetry: A Review of the Literature. Aesthet Surg J 2017; 37:375-385. [PMID: 28200081 DOI: 10.1093/asj/sjw271] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Facial symmetry is intimately correlated with attractiveness. Perfect facial symmetry is disconcerting and a degree of facial asymmetry is considered normal. There is a lack of data on the limits of normality across facial subunits. Objectives This systematic review aims to establish categories of facial asymmetry perception for facial aesthetic units by establishing a discriminative threshold of "deformity perception" across facial subunits and a threshold for intervention (unacceptable asymmetry). Methods A review of the literature was performed across Medline and Embase databases using OvidSP. All prospective studies evaluating the perception of progressive facial asymmetry in laymen or clinicians using a two- or three-dimensional model were included. Studies that did not evaluate rates of perception at varying degrees of asymmetry were excluded as these did not allow for the identification of a perceptive threshold. Results Each facial feature possesses a unique threshold of perception defined by an abrupt, statistically significant increase in detection. Asymmetry of the eyelid position at rest is the most sensitive facial feature (perceptive threshold, 2 mm) (P < 0.02). This is followed by deviations of the oral commissure (3 mm) (P < 0.001), brow position (3.5 mm) (P < 0.001), nasal tip deviation (4 mm) (P < 0.001), and chin deviation (6 mm) (P < 0.001). Desire for surgery for worsening deformities beyond the intervention threshold is characterized by an exponential, rather than linear, correlation. Conclusions Categories of facial asymmetry perception establish a framework to counsel patients with facial asymmetries, and are a valuable adjunct to clinical judgment in the management of static and dynamic facial deformities.
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Affiliation(s)
- Tim T. Wang
- From the Department of Plastic, Reconstructive, and Hand Surgery, Concord Hospital, Sydney, Australia
| | - Louis Wessels
- From the Department of Plastic, Reconstructive, and Hand Surgery, Concord Hospital, Sydney, Australia
| | - Gazi Hussain
- From the Department of Plastic, Reconstructive, and Hand Surgery, Concord Hospital, Sydney, Australia
| | - Steve Merten
- From the Department of Plastic, Reconstructive, and Hand Surgery, Concord Hospital, Sydney, Australia
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Stone A, Potton A. Emotional responses to disfigured faces and Disgust Sensitivity: An eye-tracking study. J Health Psychol 2017; 24:1191-1200. [DOI: 10.1177/1359105317692856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Facial disfigurement attracts attention and evokes negative emotion, but evidence is lacking for a link between these two reactions. The present experiment ( n = 29) investigated emotional and attentional reactions to photographs of people with disfigured faces. An eye-tracker was used to measure fixation on internal expressive features and on the forehead. Disfigurement to the internal expressive features invoked a stronger emotional reaction than disfigurement to the forehead. Attention in the area of disfigurement was associated with negative emotion (embarrassment, sympathy, disgust, repulsion) as well as surprise. Attention to the disfigurement, and negative emotion, was related to the trait of Disgust Sensitivity.
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Abstract
Scars of the cheek resulting from all causes can extol significant psychological toll. The cheek is the largest facial subunit and visually and aesthetically prominent making scars in this region difficult to ignore. An approach to scar management that targets specific characteristics of a scar using a combination of surgical and nonsurgical modalities can significantly improve the appearance of most scars. The ideal time to revise a scar should be based on the extent of scar maturation and presence or absence of any functional distortion.
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Banks CA, Jowett N, Hadlock CR, Hadlock TA. Weighting of Facial Grading Variables to Disfigurement in Facial Palsy. JAMA FACIAL PLAST SU 2016; 18:292-8. [DOI: 10.1001/jamafacial.2016.0226] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Caroline A. Banks
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Harvard Medical School/Massachusetts Eye and Ear Infirmary, Boston
| | - Nate Jowett
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Harvard Medical School/Massachusetts Eye and Ear Infirmary, Boston
| | - Charles R. Hadlock
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts
| | - Tessa A. Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Harvard Medical School/Massachusetts Eye and Ear Infirmary, Boston
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Ishii L, Dey J, Boahene KDO, Byrne PJ, Ishii M. The social distraction of facial paralysis: Objective measurement of social attention using eye-tracking. Laryngoscope 2015; 126:334-9. [DOI: 10.1002/lary.25324] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa Ishii
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Jacob Dey
- Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Kofi D. O. Boahene
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Patrick J. Byrne
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins School of Medicine; Baltimore Maryland U.S.A
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Abstract
BACKGROUND Linear closure (LC) is the most common reconstructive design for cutaneous defects. Successful performance of a LC is dependent on both appropriate surgical planning and technical execution. OBJECTIVE To review the design and execution of LCs on the face. MATERIALS AND METHODS A systematic evaluation of LCs is provided to guide a logical approach for the repair of cutaneous facial defects. RESULTS Reproducibly excellent aesthetic and functional results may be achieved with strategies that reduce incisional tension, preserve free margin position, and restore skin contour. Cosmetic unit borders and relaxed skin tension lines may be used to further camouflage facial scars. A comprehensive knowledge of facial anatomy, biomechanical properties of the skin, and incisional tension vectors facilitates correct preoperative planning and intraoperative technique. CONCLUSION Proper design and execution of LCs allow for enhanced cosmesis and permit the cutaneous surgeon to progress to more technically advanced surgical procedures such as cutaneous flaps.
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Haworth R, Sobey S, Chorney JM, Bezuhly M, Hong P. Measuring attentional bias in children with prominent ears: A prospective eye-tracking study. J Plast Reconstr Aesthet Surg 2015; 68:1662-6. [PMID: 26355000 DOI: 10.1016/j.bjps.2015.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/21/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM When observing new faces, most people focus their attention on the central triangle of the face containing the eyes, nose and mouth. When viewing faces with prominent ears, observers may divert their attention from the central triangle. The objective of this study was to determine whether there was an objective attentional bias to prominent ears in comparison to non-prominent ears. METHODS A total of 24 naïve participants (13 female; mean age 22.88 years) viewed 15 photographs of children with bilateral prominent ears, unilateral prominent ears and non-prominent ears. Both pre- and post-otoplasty photographs of two patients were included. The eye movements of participants were recorded using the EyeLink 1000, a table-mounted eye-tracking device. RESULTS Overall, the participants spent more time looking at the ear regions for faces with prominent ears in comparison to faces without prominent ears (p = 0.007, Z = -2.688). The attentional bias to the ear region of the patient who underwent bilateral otoplasty was significantly reduced in the post-operative photograph (p = 0.011, Z = -2.534). The patient who underwent unilateral otoplasty had no significant change in fixation times towards the ear region (p = 0.594, Z = -0.533). CONCLUSIONS This study presents objective data to support the notion that observers show attentional bias to the ear region when viewing faces of children with prominent ears. The scope of this finding requires further research in both extent and impact.
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Affiliation(s)
- Rebecca Haworth
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Sobey
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill M Chorney
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada; School of Human Communication Disorders, Dalhousie University, Halifax, Nova Scotia, Canada.
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van Schijndel O, Litschel R, Maal TJJ, Bergé SJ, Tasman AJ. Eye tracker based study: Perception of faces with a cleft lip and nose deformity. J Craniomaxillofac Surg 2015; 43:1620-5. [PMID: 26298551 DOI: 10.1016/j.jcms.2015.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
AIM Quantification of visual attention directed towards cleft stigmata and its impact on the perception of selected personality traits. METHODS Forty observers were divided into two groups and their visual scan paths were recorded. Both groups observed a series of photographs displaying full frontal views of the faces of 18 adult patients with clefts, nine with residual cleft stigmata and nine with digitally-corrected stigmata (each patient only appeared once per series). Patients that appeared with residual stigmata in one series appeared digitally corrected in the other series and vice versa. Visual fixation times on the upper lip and nose were compared between the original and corrected photographs. Observers subsequently rated personality traits as perceived using visual analogue scales and the same photographs that they had observed in the series. RESULTS In faces depicting cleft stigmata observers spent more time looking at the oronasal region of interest, followed by the eyes (39.6%; SD 5.0 and 35.1%; SD 3.6, respectively, p = 0.0198). Observers spent more time looking at the cleft lip compared with the corrected lip (21.2%; SD 4.0 and 16.7%; SD 5.0, respectively, p = 0.006). The differences between questionnaire scores for faces with cleft stigmata compared with faces with corrected stigmata for withdrawn-sociable, discontent-content, lazy-assiduous, unimaginative-creative, unlikeable-likeable, and the sum of individual personality traits were not significant. CONCLUSION According to these findings, cleft lip and cleft nose have an attention-drawing potential with the cleft lip being the major attention drawing factor. These data do not provide supportive evidence for the notion reported in literature that patients with clefts are perceived as having negative personality traits.
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Affiliation(s)
- Olaf van Schijndel
- Department of Oral and Maxillofacial Surgery (Head: Prof. S.J. Bergé), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| | - Ralph Litschel
- Rhinology and Facial Plastic Surgery (Head: Prof. S. Stöckli), Department of Otolaryngology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery (Head: Prof. S.J. Bergé), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Stefaan J Bergé
- Department of Oral and Maxillofacial Surgery (Head: Prof. S.J. Bergé), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Abel-Jan Tasman
- Rhinology and Facial Plastic Surgery (Head: Prof. S. Stöckli), Department of Otolaryngology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Litschel R, Majoor J, Tasman AJ. Effect of Protruding Ears on Visual Fixation Time and Perception of Personality. JAMA FACIAL PLAST SU 2015; 17:183-9. [DOI: 10.1001/jamafacial.2015.0078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ralph Litschel
- Department of Otorhinolaryngology–Head and Neck Surgery, Cantonal Hospital, St Gallen, Switzerland
| | - Juleke Majoor
- Department of Otorhinolaryngology–Head and Neck Surgery, Cantonal Hospital, St Gallen, Switzerland
| | - Abel-Jan Tasman
- Department of Otorhinolaryngology–Head and Neck Surgery, Cantonal Hospital, St Gallen, Switzerland
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Abstract
BACKGROUND Physical appearance influences nearly every aspect of human life-impacting how people are judged and subsequently treated by others. OBJECTIVE To summarize the literature that addresses the psychosocial impact of facial scarring, with a particular emphasis on scarring after skin cancer treatment. MATERIALS AND METHODS A comprehensive PubMed search was conducted to find articles related to scarring and appearance in the contexts of cutaneous oncology and surgical reconstruction. References from retrieved articles were also considered for review. RESULTS Scars, especially on the head and neck, change physical appearance and can negatively impact psychosocial functioning. Medical professionals may underestimate the importance of physical appearance for patients with skin cancer. Validated patient-reported outcome (PRO) tools may prove better than objective scar ratings to identify patients who may experience psychosocial impairment from scarring. CONCLUSION Scarring after skin cancer surgery can profoundly affect psychosocial functioning. Perioperative use of validated PRO tools can help to identify patients with scar concerns. Heightened awareness of patients' psychosocial status will allow practitioners to offer appropriate counseling or support.
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Dey JK, Ishii LE, Byrne PJ, Boahene KDO, Ishii M. The Social Penalty of Facial Lesions. JAMA FACIAL PLAST SU 2015; 17:90-6. [DOI: 10.1001/jamafacial.2014.1131] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jacob K. Dey
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa E. Ishii
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J. Byrne
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D. O. Boahene
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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