Assessing Attentional Bias in Secondary Cleft Lip Deformities: An Eye-Tracking Study

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.