Managing Oral Surgery in von Willebrand Disease: Lessons from a Challenging Case

Von Willebrand disease is a rare inherited bleeding disorder characterized by deficient or defective von Willebrand factor, crucial for platelet adhesion and aggregation. This case report aims to highlight the challenges of diagnosing undiagnosed von Willebrand disease in dental practice and to describe a multidisciplinary management approach to prevent life-threatening complications during oral surgery. A 32-year-old male with no significant medical history underwent surgical extraction of an impacted third molar. The patient experienced severe intraoperative bleeding unresponsive to standard local hemostatic measures. Subsequent hematological evaluation confirmed Type I von Willebrand disease. For the extraction of the remaining impacted molars, a tailored protocol was implemented, including preoperative administration of von Willebrand factor-containing factor VIII concentrates, tranexamic acid therapy, local hemostatic agents, and close perioperative monitoring in collaboration with hematology specialists. The initial procedure resulted in excessive bleeding, leading to the diagnosis of von Willebrand disease. Following the implementation of the multidisciplinary protocol, the patient underwent multiple extractions without immediate or delayed bleeding complications. Hemoglobin levels remained stable postoperatively, and the patient reported satisfactory pain control. Early identification and tailored management of bleeding disorders are critical in oral surgery to prevent severe hemorrhagic complications. A multidisciplinary approach involving dentists, oral surgeons, and hematologists ensures safe and effective care for patients with von Willebrand disease, emphasizing the importance of comprehensive preoperative assessments and structured treatment protocols.