About

Pedro E Santiago is an Associate Professor of Surgery at Duke University. He is affiliated with the Department of Surgery, specifically within the Division of Plastic, Maxillofacial, and Oral Surgery. His professional role involves integrated plastic and reconstructive surgery, contributing to the residency program in this specialty. Based at the Duke Craniofacial Orthodontics/Aesthetic Center in Durham, North Carolina, Dr. Santiago's work focuses on advancing surgical techniques and patient care within his field. His position underscores his involvement in both clinical practice and academic activities related to plastic and reconstructive surgery.

Research topics

• Medicine
• Surgery
• Nursing
• Operations management
• Dentistry
• Medical emergency

Selected publications

• Systematic Review and Critical Appraisal of the Evidence Base for Nasoalveolar Molding (NAM)

  The Cleft Palate-Craniofacial Journal · 2022-11-04 · 24 citations

  reviewSenior author

  OBJECTIVE: To critically appraise the body of scientific literature supporting the risks and efficacy of nasoalveolar molding (NAM), specifically in contrast to alternative methods of presurgical infant orthopedics (PSIO) or to treatment without PSIO. MAIN OUTCOME MEASURES: Five outcome domains were considered: nasolabial aesthetics; dentoalveolar relationship; midfacial growth; cost and burden of care; and number of anesthetic events. DESIGN: MEDLINE, Embase, and Scopus were queried for articles from the first description of the Grayson-Santiago NAM technique (1993) through December 13, 2021. After the application of inclusionary and exclusionary criteria, selected articles were critically appraised using a systematic framework that included risk of bias assessment using the Cochrane RoB 2.0 and ROBINS-I tools. RESULTS: A total of 88 studies were included. Level-I and -II evidence showed on par or better approximation and alveolar alignment achieved by NAM compared to other PSIO. Level-II and -III evidence showed improved nasolabial aesthetics compared to other PSIOs. Level-II and -III evidence supported no harm to maxillofacial skeletal growth through age 12. Sparse level-III evidence supported a reduced number of labial or nasal revisions following NAM. Level-II and -III evidence showed NAM requiring upfront cost and frequent appointments but reducing caregiver psychosocial burden and reducing long-term costs compared to select alternatives. Many studies carried a high risk of bias. CONCLUSIONS: Current evidence supports the overall efficacy of NAM regarding short/mid-term outcomes, with a low risk of negative effects on midfacial growth or dental development. The high risk of bias discovered in many papers underscores the need for robust study design in future research.

  PublisherDOI

• The First Hybrid International Educational Comprehensive Cleft Care Workshop

  The Cleft Palate-Craniofacial Journal · 2022-05-09 · 9 citations

  articleOpen access

  Objective Describe the first hybrid global simulation-based comprehensive cleft care workshop, evaluate impact on participants, and compare experiences based on in-person versus virtual attendance. Design Cross-sectional survey-based evaluation. Setting International comprehensive cleft care workshop. Participants Total of 489 participants. Interventions Three-day simulation-based hybrid comprehensive cleft care workshop. Main Outcome Measures Participant demographic data, perceived barriers and interventions needed for global comprehensive cleft care delivery, participant workshop satisfaction, and perceived short-term impact on practice stratified by in-person versus virtual attendance. Results The workshop included 489 participants from 5 continents. The response rate was 39.9%. Participants perceived financial factors (30.3%) the most significant barrier and improvement in training (39.8%) as the most important intervention to overcome barriers facing cleft care delivery in low to middle-income countries. All participants reported a high level of satisfaction with the workshop and a strong positive perceived short-term impact on their practice. Importantly, while this was true for both in-person and virtual attendees, in-person attendees reported a significantly higher satisfaction with the workshop (28.63 ± 3.08 vs 27.63 ± 3.93; P = .04) and perceived impact on their clinical practice (22.37 ± 3.42 vs 21.02 ± 3.45 P = .01). Conclusion Hybrid simulation-based educational comprehensive cleft care workshops are overall well received by participants and have a positive perceived impact on their clinical practices. In-person attendance is associated with significantly higher satisfaction and perceived impact on practice. Considering that financial and health constraints may limit live meeting attendance, future efforts will focus on making in-person and virtual attendance more comparable.

  PublisherOA PDFDOI

• Time-Driven, Activity-Based Costing of Presurgical Infant Orthopedics: A Critical Component of Establishing Value of Latham Appliance and Nasoalveolar Molding

  Plastic & Reconstructive Surgery · 2021 · 13 citations

  • Medicine
  • Operations management
  • Medical emergency

  BACKGROUND: Value-based health-care reform requires assessment of outcomes and costs of medical interventions. In cleft care, presurgical infant orthopedics is still being evaluated for clinical benefits and risks; however, the cost of these procedures has been largely ignored. This study uses robust accounting methods to quantify the cost of providing two types of presurgical infant orthopedics: Latham appliance treatment and nasoalveolar molding. METHODS: This is a prospective study of patients with nonsyndromic cleft lip and/or palate who underwent treatment with presurgical infant orthopedics from 2017 to 2019 at two academic centers. Costs were measured using time-driven activity-based costing. Personnel costs, facility costs (operating room, clinic, and inpatient ward), and equipment costs were included. Travel expenses were incorporated as an estimate of direct costs borne by the family, but indirect costs (e.g., time off from work) were not considered. RESULTS: Twenty-three patients were treated with Latham appliance treatment and 14 were treated with nasoalveolar molding. For Latham appliance treatment, average total cost was $7553 per patient ($1041 for personnel, $637 for equipment, $4871 for facility, and $1004 for travel over 6.5 visits). Unilateral and bilateral costs were $6891 and $8860, respectively. For nasoalveolar molding, average cost totaled $2541 ($364 for personnel, $151 for equipment, $300 for facility, and $1726 for travel over 13 visits); $2120 for unilateral and $3048 for bilateral treatment. CONCLUSIONS: The major difference in cost is attributable to operative placement of the Latham device. Travel cost for nasoalveolar molding is often higher because of frequent clinical encounters required. Future investigation should focus on whether outcomes achieved by presurgical infant orthopedics justify the $2100 to $8900 expenditure for these adjunctive procedures.

  PublisherDOI

• Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education

  The Cleft Palate-Craniofacial Journal · 2020-07-30 · 13 citations

  articleOpen access

  Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. Design: Cross-sectional survey-based evaluation. Setting: Simulation-based comprehensive cleft care workshop. Participants: Total of 180 participants. Interventions: Three-day simulation-based comprehensive cleft care workshop. Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants’ clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

  PublisherOA PDFDOI

• NAM Therapy—Evidence-Based Results

  The Cleft Palate-Craniofacial Journal · 2020 · 39 citations

  • Medicine
  • Dentistry
  • Surgery

  Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

  PublisherDOI

• Time-Driven, Activity-Based Costing of Presurgical Infant Orthopedics: A Critical Component of Establishing Value of Latham Appliance and Nasoalveolar Molding

  Plastic & Reconstructive Surgery Global Open · 2020-09-01

  articleOpen access

  BACKGROUND: Value-based healthcare reform requires assessment of outcomes and costs of medical interventions. In cleft care, presurgical infant orthopedics (PSIO) is still being evaluated for clinical benefits and risks; however, cost of these procedures has been largely ignored. This study employs robust accounting methods to quantify the cost of providing 2 variants of PSIO: Latham and nasoalveolar molding (NAM). METHODS: This is a prospective study of patients with nonsyndromic cleft lip and/or palate who underwent PSIO from 2017 to 2019 at 2 academic centers. Costs were measured using time-driven activity-based costing. Personnel costs, facility costs (operating room, clinic, and inpatient ward), and equipment costs were included. Travel expenses were included as an estimate of direct costs borne by the family, but indirect costs (eg, time off from work) were not considered. FINDINGS: Twenty-three patients were treated with Latham and 14 with NAM. For Latham, average cost totaled $7,553/patient ($1,041 for personnel, $637 for equipment, $4,871 for facility, and $1,004 for travel over 6.5 visits). Unilateral and bilateral Latham costs were $6,891 and $8,860, respectively. For NAM, average cost totaled $2,541 ($364 for personnel, $151 for equipment, $300 for facility, and $1,726 for travel over 13 visits); $2,120 for unilateral and $3,048 for bilateral treatment. CONCLUSIONS: The major difference in cost is attributable to operative placement of the Latham’ device. Travel cost for NAM is often higher due to frequent clinical encounters required. Future investigation should focus on whether outcomes achieved by PSIO justify the $2,100–$8,900 expenditure for these adjunctive procedures.

  PublisherDOI

• Principles of Cleft Lip Repair: Conventions, Commonalities, and Controversies

  Plastic & Reconstructive Surgery · 2017-02-25 · 55 citations

  articleSenior author

  LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Understand the principles of contemporary methods for repair of unilateral and bilateral cleft lip. 2. Understand the design elements of a poor repair that predispose to a suboptimal outcome. SUMMARY: The authors describe the evaluation and management of unilateral and bilateral cleft lip (with or without cleft alveolus and with or without cleft palate). Each deformity is presented in a "principles-based" manner. For unilateral cleft lip, the authors discuss common modifications of rotation-advancement and Fisher's anatomical subunit approach. In expert hands, both techniques can give excellent results. For bilateral cleft lip, Mulliken's method is presented. Methods for synchronous correction of the cleft lip nasal deformity are also discussed.

  PublisherDOI

• Clinician's Primer to ICD-10-CM Coding for Cleft Lip/Palate Care

  The Cleft Palate-Craniofacial Journal · 2015-11-02 · 14 citations

  article

  On October 1, 2015, the United States required use of the Clinical Modification of the International Classification of Diseases, 10th Revision (ICD-10-CM) for diagnostic coding. This primer was written to assist the cleft care community with understanding and use of ICD-10-CM for diagnostic coding related to cleft lip and/or palate (CL/P).

  PublisherDOI

• Dental Anatomy and Occlusion

  2014-10-29 · 20 citations

  book-chapter1st authorCorresponding
  PublisherDOI

• Management of the Alveolar Cleft

  Clinics in Plastic Surgery · 2014-03-05 · 55 citations

  review1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Alexander C. Allori

  Duke University

  74 shared

• Bonnie L. Padwa

  Boston Children's Hospital

  49 shared

• John G. Meara

  Harvard University

  47 shared

• Barry H. Grayson

  46 shared

• Karl Sanchez

  Harvard University

  45 shared

• Banafsheh Sharif‐Askary

  MedStar Georgetown University Hospital

  45 shared

• Olivia C. Langa

  Boston Children's Hospital

  45 shared

• Ingrid M. Ganske

  Harvard University

  45 shared