Perception of the Nose and Lower Face Before and After Orthognathic Surgery in Subjects with Dento-maxillofacial Deformities: An Eye-Tracking Study.

BACKGROUND: Dento-maxillofacial deformities are often associated with nasal deviation, and patients often complain of nasal deviation after orthognathic surgery. This study aimed to quantitatively evaluate the facial visual attention given to dento-maxillofacial deformities accompanying nasal deviation from the perspective of patients and determine whether orthognathic surgery could alter this outcome. METHODS: The scanning paths of 137 patients were recorded using an eye-tracking device; recordings were made while the patients viewed images of dento-maxillofacial deformities associated with various degrees of nasal deviation before or after orthognathic surgery. Visual attention focused on the lower face and nose was analyzed. RESULTS: When viewing postoperative faces, the participants focused more visual attention on noses and less on the lower face than they did on preoperative faces. Interestingly, for preoperative faces, nasal deviation could significantly increase participants' visual attention to the lower face, and visual attention to noses was significantly increased when noses were deviated 12°, while for postoperative faces, a nasal deviation of 4° or more was associated with a significant increase in participants' visual attention to the nose. CONCLUSIONS: Patients tended to focus their visual attention on the lower region of preoperative faces and ignored nose irregularities. Orthognathic surgery can alter visual attention, shifting it from the lower face to the nose, and a deviation of 4° or more could be a potential concern for patients. Clinicians must inform patients preoperatively about preexisting nasal deviations, which can guide surgical planning and help manage patient expectations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective assessment of visual attention in orthognathic surgery training based on eye tracking.

The aim of this study was to investigate the differences in visual attention between novices and orthognathic experts, as well as to provide evidence for use in developing and optimizing training strategies for orthognathic surgery. Novice and orthognathic experts were recruited, and their distributions of visual attention were monitored via an eye-tracking device while they watched orthognathic surgery videos. The percentages of visual fixation duration devoted to the areas of interest - surgical objects, instruments controlled by the main surgeon, and instruments controlled by the assistants - in each orthognathic surgery section were analyzed and compared between the two groups using repeated-measures factorial analysis of variance (ANOVA). In total, there were 18 participants, comprising both novices (n = 9) and experts (n = 9). For all sections of orthognathic surgery, the percentage of fixation duration on surgical objects was significantly higher for the novices than for the experts (p = 0.031, p = 0.005, p = 0.026, p = 0.047, p = 0.047, p = 0.031, p = 0.027, p = 0.034, p = 0.008, and p = 0.016). During the maxillary segment separation as part of Le Fort I osteotomy and the splitting of the mandible as part of bilateral sagittal split osteotomy, the novices also had a higher percentage of fixation duration on the instruments controlled by the main surgeon, as compared with the experts (p = 0.007 and p = 0.048, respectively). Novices invested great cognitive effort into the surgical objects in each section of orthognathic surgery, including the instruments controlled by the main surgeon in the maxillary segment separation and the splitting of the mandible. Strengthening this aspect of instruction could help novices reduce their cognitive load and achieve mastery more efficiently.

Exploring the distribution of visual attention in genioplasty trainees using eye-tracking technology.

PURPOSE: This study aimed to investigate the visual attention of genioplasty trainees using eye-tracking technology, with the goal of providing insights for optimizing genioplasty training strategies. METHODS: Trainees were recruited for the study, and their visual attention distribution was monitored with an eye-tracking device while they watched a genioplasty procedure video. The percentage of fixation durations dedicated to areas of interest (surgical objects, instruments manipulated by the primary surgeon, and instruments controlled by assistants) were analyzed for each phase of the procedure. RESULTS: A total of 20 surgical trainees (8 males, 12 females; mean age, 27.8 years; range, 22-35 years) participated in the study. During the soft tissue reflection phase, trainees' percentage fixation durations on instruments controlled by the primary surgeon were higher than on surgical objects, but the difference was not significant (p > 0.05). The percentage fixation durations on instruments controlled by assistants were significantly lower than on those controlled by the primary surgeon or on surgical objects (p < 0.05). In the osteotomy, bone fixation, and suturing phases, the percentage fixation durations on surgical objects were highest, followed by instruments manipulated by the primary surgeon and those controlled by assistants, with significant differences (p < 0.05). CONCLUSION: Surgical trainees need to invest significant cognitive effort in focusing on the instruments manipulated by the primary surgeon and the surgical objects during the soft tissue reflection phase, as well as on surgical objects during the osteotomy, fixation, and suturing phases. Emphasizing these elements during instruction can help trainees reduce their cognitive load and effectively master genioplasty techniques.