Jaw Deformity Linked to Increased Attentional Bias and Dysmorphic Concern

The Perceptual Burden of Maxillofacial Malocclusion

Structural jaw deformities often necessitate complex interventions, ranging from orthodontic camouflage to orthognathic surgery, to address both functional and aesthetic deficits [1]. Beyond the immediate dental implications, these skeletal malocclusions can significantly impact pharyngeal airway dimensions and respiratory health [2]. Clinicians frequently utilize three dimensional soft tissue simulations to plan these procedures, yet the accuracy of predicting post-operative appearance remains a challenge, particularly in the paranasal and lip regions [3]. While the physical consequences of malocclusion extend to body posture and gait parameters, the psychological burden of these deformities is equally profound [4]. Although surgical advancements like maxillomandibular advancement offer high success rates for conditions such as obstructive sleep apnea, the patient's subjective perception of their facial structure remains a critical component of treatment satisfaction [5]. A recent study now investigates the specific visual processing patterns that characterize how these patients perceive their own and others' facial features, offering a deeper look into the cognitive impact of structural anomalies.

Quantifying Dysmorphic Concern in Surgical Candidates

To investigate the psychological dimensions of structural facial anomalies, the researchers evaluated a cohort of 60 patients with jaw deformities. This clinical group was compared against 40 age-matched individuals who served as a control group to establish a baseline for appearance-related perceptions. All participants completed the Body Image Concern Inventory (BICI), which is a validated 19-item psychometric tool designed to quantify the degree of distress, preoccupation, and social impairment resulting from perceived physical flaws, a concept known as dysmorphic appearance concern. By employing this standardized instrument, the study sought to provide a rigorous metric for the psychological burden that often accompanies objective skeletal malocclusions, moving beyond anecdotal reports of patient dissatisfaction. The results of the assessment revealed that patients with jaw deformities exhibited significantly higher BICI scores than the control group, indicating a substantial increase in psychological morbidity related to their condition. The data confirm that individuals with jaw deformities exhibit elevated dysmorphic appearance concern, suggesting that the physical severity of a jaw deformity is frequently mirrored by a heightened internal preoccupation with facial aesthetics. For the practicing clinician, these findings emphasize that the impact of a jaw deformity extends beyond functional or structural deficits; because these patients experience significantly greater distress regarding their appearance than their age-matched peers, incorporating psychological screening into the preoperative workup may be essential for managing patient expectations and improving overall treatment outcomes.

Eye-Tracking Reveals Maladaptive Scanning Patterns

To investigate the cognitive processes underlying appearance concern, the researchers utilized eye-tracking technology to measure appearance-related attentional bias (the tendency for the brain to focus disproportionately on specific physical features while ignoring others). This phenomenon is a documented mechanism in body dysmorphic disorder and serves as a general perceptual-cognitive mechanism for appearance monitoring across various clinical populations. During the study, the 60 patients and 40 controls underwent eye-tracking while viewing two distinct sets of stimuli: photographs of their own faces (self-face viewing) and photographs of other people's faces (other-face viewing). The researchers analyzed gaze duration across six specific anatomical regions, which included the forehead, eyes, nose, mouth, jaw, and a category for other facial areas. The data revealed distinct differences in how patients processed facial images compared to the control group. During self-face viewing, patients showed prolonged gaze in the jaw region compared to controls, suggesting a heightened fixation on their own perceived structural deficit. This pattern was not limited to self-perception; during other-face viewing, patients also showed prolonged gaze in the jaw region compared to controls. These results indicate that individuals with jaw deformities exhibit increased attention to perceptually salient features, specifically the jaw region, regardless of whose face they are observing. For the clinician, these findings suggest that jaw deformities are associated with a persistent scanning bias. This hyper-focus on the jaw area may reinforce the psychological distress measured by the Body Image Concern Inventory, as patients appear to reflexively prioritize the evaluation of the lower face in both themselves and others, potentially leading to an overestimation of the deformity's impact on their social interactions.

Clinical Implications of Fixation and Distress

The study specifically investigated whether attentional biases, which are well-documented in psychiatric conditions, also occur in individuals with objectively verifiable jaw deformities. To quantify the relationship between visual behavior and psychological state, the researchers examined associations between gaze patterns and scores on the Body Image Concern Inventory. Exploratory correlation analyses within the patient group revealed that gaze duration in the jaw region was positively associated with BICI scores for self-faces, indicating that patients with the highest levels of appearance-related distress spent the most time fixating on their own jaw during the eye-tracking tasks. This relationship suggests that the physical deformity is not merely a functional issue but is deeply integrated into the patient's self-perception and cognitive monitoring processes. This maladaptive scanning pattern extended beyond the self, as the exploratory correlation analyses also showed that gaze duration in the jaw region was positively associated with BICI scores within the patient group for other's faces. For the practicing surgeon, these findings underscore the importance of recognizing that orthognathic intervention (the surgical correction of jaw and facial skeletal irregularities) occurs within a complex psychological framework. Because increased attention to the jaw region correlates with higher dysmorphic concern, identifying these perceptual-cognitive processes (the mental mechanisms by which patients focus on and interpret physical features) may be vital for managing patient expectations. Clinicians may use these insights to identify patients who require integrated psychological support alongside surgical treatment, ensuring that the correction of an objective deformity also addresses the underlying subjective distress and attentional fixation that surgery alone may not fully resolve.

References

1. Alhammadi MS, Almashraqi AA, Khadhi AH, et al. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review. Clinical Oral Investigations. 2022. doi:10.1007/s00784-022-04685-6

2. Rodrigues J, Evangelopoulos E, Anagnostopoulos I, et al. Impact of class II and class III skeletal malocclusion on pharyngeal airway dimensions: A systematic literature review and meta-analysis. Heliyon. 2024. doi:10.1016/j.heliyon.2024.e27284

3. Olejnik A, Verstraete L, Croonenborghs T, Politis C, Swennen G. The Accuracy of Three-Dimensional Soft Tissue Simulation in Orthognathic Surgery—A Systematic Review. Journal of Imaging. 2024. doi:10.3390/jimaging10050119

4. Różańska-Perlińska D, Potocka-Mitan M, Rydzik Ł, et al. The Correlation between Malocclusion and Body Posture and Cervical Vertebral, Podal System, and Gait Parameters in Children: A Systematic Review. Journal of Clinical Medicine. 2024. doi:10.3390/jcm13123463

5. Walker AM, Kassir MF, Sama V, Nguyen SA, Abdelwahab M. Maxillomandibular Advancement Safety and Effectiveness in Obstructive Sleep Apnea: Systematic Review and Meta‐Analysis. Otolaryngology. 2025. doi:10.1002/ohn.1114