Plastic Surgery Research Council

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Visual Perception of Asymmetry in Parry Romberg Disease: A Pre- and Post-Surgical Eyetracking Analysis
Thanapoom M. Boonipat1, Amjed Abu-Ghname, MD1, Ali Charaffadine, MD1, Kevin D. Fleming2, Uldis Bite1, Mitchell Stotland3, Samir Mardini, MD1.
1Mayo Clinic, ROCHESTER, MN, USA, 2Norwich University, Northfield, VT, USA, 3Sidra Medical, Doha, Qatar.

PURPOSE:
The availability of an objective outcome measure for facial reconstructive surgery remains elusive. Subjective ratings, or objective measures such as anthropometric analysis, may unreliably convey how one is perceived by others. We are interested in observers' instantaneous, reflexive responses to the Parry Romberg face, and how those instinctive responses relate to subjective judgment of a given face. We explored the visual markers of Parry Romberg patients compared to the expected norm. By examining the early stages of visual processing that occur, we intended to measure changes in the focus of impression formation, thereby helping surgeons and their patients prioritize areas for reconstruction. METHODS:Pre and post operation (>3 months) photographs from 6 patients with unilateral hemifacial atrophy who underwent reconstruction with fat grafting/ADM/implant/free tissue transfer were obtained. Twenty lookzone regions were mapped onto each facial image, reflecting aesthetic units of the face. 40 observers examined each images while an infrared eye-tracking camera continuously recorded their eye movements. The observers were then asked to rate the image for character attributes (attractiveness, trustworthiness, sociability, healthy, and capability, 1-7 scale). Factorial ANOVA and student t-test analysis was performed to determine significance of differences between groups. The total number of eye fixations within different lookzone regions was recorded. Eyetracking data of pre- and post-operative images were analyzed and compared. RESULTS:(i) The affected side upper lip and and periorbital region draw the most attention, compared to control subjects. (ii) The areas of disproportion draw the most attention. (iii) Our eye tracking methodology clearly reflects a trend towards normalization of gaze attention following surgical intervention. This finding was associated with the improvement in character assessment of the images in the post-op cohort of images. CONCLUSION: We provide data illustrating a novel and objective technique to evaluate perception of Parry Romberg faces, and the effect of reconstructive intervention to correct this abnormal perception. This information may be used to inform patients about how facial difference are perceived, and the potential effect that surgical intervention may have on others' perception of them. This work may assist patients and their surgeons to more meaningfully focus their surgical decision-making priorities.


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