Method: 76 participants underwent one eyetracking session. After being positioned and calibrated subjects were shown 24 unique composite images repeated twice for reliability. These images reflected a repaired unilateral cleft lip or three levels of malocclusion, similar to those of levels 1, 7, and 10 of the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN), which were embedded in faces of three levels of attractiveness: attractive, average, unattractive. During viewing, data were collected for the first location, frequency, and duration of the participants’ gaze.
Result: Observer reliability ranged from ICC .44 to .89, but was .00 to .19 for the area of first gaze, and 00 to .31 for the chin, which were both eliminated from the study. Repeated-measures ANOVA showed a significant effect (p<0.001) between level of attractiveness, malocclusion, and area of the face. For both number of fixations and duration of fixations the eyes overwhelmingly were most salient. In all but 13 of 452 combinations of malocclusion and attractiveness levels that included the eyes, the eyes received significantly more visual attention than the second most observed area, the mouth. As the malocclusions became more severe the visual attention increased on the oral/circumoral area, sometimes approaching that of the eyes. IOTN level 10 gained the most attention followed by both IOTN level 7 and the cleft. IOTN level 1 received the least amount of visual attention.
Conclusion: Precise eyetracking and not self-reports indicate that malocclusion, repaired unilateral cleft lip, and facial attractiveness affect the areas of the face viewed by layperson.