Parents of Children with Cleft Lip Exhibit Heightened Visual Attention to the Perioral Area

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.

Fig. 1.

For each facial image, eighteen facial regions of interest (ROIs) were assigned and analyzed post hoc after the eye-tracking protocol. The ROIs were labeled as forehead (1,2); periorbital (3,4); glabellar (5,6); infraorbital (7,8); lateral nasal sidewall (9,10); mid-cheek (11,12); nasal tip, nares, and columella (13,14); upper lip (15,16); lower lip, chin, mandible (17,18). Image accessed from internet, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Fig. 2.

Parents’ versus naive observers’ visual fixation of bilateral ROIs when viewing repaired cleft lip (CL) images. P−, nonparental controls; P+, parents of patients with CL.

Fig. 3.

Parents’ versus naive observers’ visual fixation of bilateral ROIs when viewing control images. P− (nonparental controls); P+ (parents of patients with CL).

Fig. 4.

Heatmaps representing the gaze patterns of control adult observers (P−) and parents of children with CL (P+) when viewing an image of a patient with a repaired CL (A, B) and a control image (C, D). Image (A, B) accessed from internet, (https://www.flickr.com/photos/interplast/429787606), licensed under https://creativecommons.org/licenses/by-nc-nd/2.0/, [Accessibility verified June 25, 2022]. Image (C,D) generated using the Style GAN II facial generator.