Exploring Self-Perception and Peer-Perception in Adolescents With Secondary Cleft Lip Deformities Using Eye-Tracking

Background: Patients with cleft lip often have a secondary cleft-lip deformity (SCLD), resulting from the initial repair procedure for their congenital cleft. Patients with SCLD often undergo multiple surgeries to achieve symmetry of the lip and nose. However, little is known about how patients perceive their deformity, and if those deformities are noticeable to their peers. The purpose of this study is to use eye-tracking to evaluate how patients with cleft lip repair look at themselves and evaluate how this perception changes when the same photo is perceived by 2 different cohorts: patients who have undergone cleft-lip surgeries and control subjects who have no craniofacial pathology. Methods: Participants were divided into 4 cohorts: adolescents with SCLD viewing images of themselves (Cohort 1), adolescents with SCLD viewing images of peers with SCLD (Cohort 2), adolescents without SCLD viewing images of peers with SCLD (Cohort 3), and healthy adolescents without SCLD viewing images of themselves (Cohort 4). Surveys were conducted after the eye-tracking portion to determine correlations between objective gaze data and subjective opinions. Results: Total fixation duration was highest in the eye region for all 3 cohorts, followed by the upper lip region. Cohort 2 fixated the longest on all areas of pathology, while Cohort 1 fixated the least on all areas of pathology. Cohort 4 spent significantly more time looking at the nose bridge compared to Cohort 1. Conclusions: The results provide insight into how adolescents with SCLD are perceived by themselves and others and can help to better understand the complexities of the roles different areas of pathology play in self-perception.