Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

David Liao, Lisa E. Ishii, Lena W. Chen, Jonlin Chen, Michelle Juarez, Halley M. Darrach, Anisha R. Kumar, Jonathon O. Russell, Ralph P. Tufano, Masaru Ishii

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. Methods: Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. Results: One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P <.0001). Observers attended significantly more to the neck (0.20 seconds, P <.0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (−0.24 seconds, P =.0031; 95% CI, −0.39, −0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P =.0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P =.1345). Observer race and gender did not significantly affect attention to neck scars. Conclusion: Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. Level of Evidence: NA Laryngoscope, 130:1603–1608, 2020.

Original languageEnglish (US)
Pages (from-to)1603-1608
Number of pages6
Issue number6
StatePublished - Jun 1 2020


  • Eye-tracking
  • endoscopic thyroidectomy
  • neck scar
  • transoral neck surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


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