[Willebrand factor deficiency and septorhinoplasty].
BACKGROUND
Willebrand disease can be diagnosed late, sometimes only when hemorrhage complicates surgery. French guidelines do not recommend investigation before surgery when no personal or familial hemorrhagic diathesis is reported.


OBJECTIVE
To consider the advantages of Willebrand factor dosage before septorhinoplasty.


METHODS
Three cases of septorhinoplasty and Willebrand factor deficiency complicated with hemorrhage compromising the functional result are reported. The routine tests (platelet count, bleeding time, and activated partial thromboplastin time) and Willebrand factor dosage were done before or after surgery.


RESULTS
In the three cases, no personal or familiar hemorrhagic diathesis was found. For two cases, a hemorrhage occurred during surgery. One of them had prolonged and repeated nose bleedings after surgery. In this case, iterative packings damaged the result of surgery and a new rhinoplasty had to be done. In one case, a prolonged activated partial thromboplastin time before surgery revealed a Willebrand factor deficiency, leading to prophylactic treatment (desmopressin) of bleeding.


CONCLUSIONS
The cases described suggest that systematic dosage of Willebrand factor before septorhinoplasty could be advantageous and that functional prognosis can be impaired by uncontrolled epistaxis.
Devignes
J
J
Service d'hématologie biologique, centre hospitalier universitaire de Nancy, avenue de Morvan, 54511 Vandoeuvre-Lès-Nancy, France. j.devignes@chu-nancy.fr
Saviot
A
A
de Maistre
E
E
Briquel
M-E
ME
Lecompte
T
T
Jankowski
R
R
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care; D012225:Rhinoplasty / Q000379:methods*; D014841:von Willebrand Factor / Q000008:administration & dosage* / Q000502:physiology*
D014841:von Willebrand Factor