Harris P. Mosher Award
The attention of casual observers looking at the faces of people with facial paralysis deviates from normal patterns, said researchers from Johns Hopkins School of Medicine in Baltimore, who reached their conclusions after conducting experiments using eye-tracking technology.
Explore This IssueJune 2015
Lisa Ishii, MD, a facial plastic and reconstructive surgeon and associate professor of otolaryngology-head and neck surgery at Johns Hopkins, presented the findings and captured this year’s Mosher Award for Excellence among Triological Society candidate theses on clinical research.
Dr. Ishii’s group has been examining how lay observers view facial deformities for many years, building on the basic concept, established with research in the late 1970s, that most people view “normal” faces with a focus on the “central triangle” of the eyes, nose and mouth. That has proven to be a reliable observation pattern.
“Patients who present to facial plastic surgeons express concerns about how others will view them with their facial deformities,” she said. “This is a concern for patients who have pre-existing deformities. This is a concern for patients who are going to undergo some type of procedure that will lead to a deformity…. Previously, we have had very little data on facial perception of facial deformity—in other words, how do lay people view these faces when they see abnormalities on them?”
Earlier studies have found that attention is diverted from normal patterns to the deformities: Those looking at someone with a lesion on the cheek will deviate from the central triangle and look more at that cheek area, and those looking at the face with a crooked nose will dwell longer on the nose. People can come up with “some idea about the face” after looking at a particular area for as few as 200 milliseconds, Dr. Ishii said.
In their current experiment, Dr. Ishii and her team of researchers turned to how facial paralysis is seen. Sixty casual observers viewed images of paralyzed faces and non-paralyzed faces, both smiling and in repose, but no single observer saw the same person’s face more than once, so they saw each face either smiling or in repose. The images showed faces of people ranging from 18 to 72 years old.
The researchers found that the majority of the attention was focused within the central triangle but that there was increased attention to the mouths of the paralyzed faces. They also found that those viewing paralyzed faces spent more time looking at the non-paralyzed side than the paralyzed side. “These attentional changes can be correlated with changes in perception,” Dr. Ishii said. “When they smile, they’re not perceived as emoting positively. In fact, they’re perceived as emoting negatively because of the distortion of their face. And this helps us to understand the areas to which casual observers are attending when they are making those observations.”
She said she hopes the findings, which her group intends to refine—possibly by using video images and images of less severe paralysis—can help guide reconstruction. “We can’t attack all of the deficits at once,” Dr. Ishii said. “And this helps us to start to structure where we need to focus our attention to get the greatest outcome for the patient.”
Edmund Prince Fowler Award
In another honor given at the meeting this year, the Fowler Award recognizing excellence among theses in basic science, was presented to Bradford Woodworth, MD, assistant professor of surgery and director of otolaryngology research at the University of Alabama in Birmingham, for his findings on resveratrol and mucociliary clearance.
In the study, Dr. Woodworth and his team created a model of hypoxia-induced dysfunction of cystic fibrosis transmembrane conductance regulator (CFTR) and, within that model, found that resveratrol—a non-flavonoid polyphenol—can help reverse this dysfunction.
Mucociliary clearance, the process of capturing bacteria and other airborne threats and removing them from the body, is the airway’s main innate defense against disease. It depends on proper function of the CFTR chloride transport channel. When the channel is blocked, the airway surface liquid gets dehydrated, leading to a blockage of mucociliary clearance, overgrowth of bacteria, and airway infections.
Researchers found that they could use oxygen restriction to deplete airway surface liquid with an underlying mechanism similar to cystic fibrosis, making it a useful model in which to study resveratrol’s effects in preparation for a clinical trial.
Furthermore the researchers found that they could activate transepithelial chloride transport using resveratrol, ultimately increasing the depth of the airway surface liquid. “The hypoxia-induced model is an acquired CFTR dysfunction model,” Dr. Woodworth said. “It is ameliorated and mitigated by resveratrol, and this results in improved epithelial function and ion transport.”
The findings suggest this could be a worthwhile therapeutic approach. “Essentially, it’s a good model to say, ‘Hey, we have these hypoxic defects. You can have acquired CFTR deficiency and sinus disease, and maybe chloride secretagogues could be a good approach, an innovative approach, to overcoming acquired CFTR defects in sinus disease.”