Kiesselbach's plexus: the commonest site of nosebleeds
Kiesselbach's plexus (Little's area) is the artery network on the front of the nasal septum, the wall dividing the nose, where most nosebleeds begin.
Remember
Most nosebleeds begin in Kiesselbach's plexus (Little's area), the network of arteries on the front of the nasal septum; bleeds from further back are less common and harder to control.
Memory aid
Picture five roads meeting at one busy junction at the front of the septum; the junction is where the crash, and the bleed, tends to happen.
Think of the arteries that feed the plexus (up to five) as the roads and the plexus as the junction where they meet, which is where bleeding tends to start.
Epistaxis is the medical word for a nosebleed. Most nosebleeds begin on the front of the nasal septum (the wall dividing the two sides of the nose), in a spot called Kiesselbach's plexus or Little's area. A plexus is a network of vessels, and here several arteries join one another. A join between two vessels is called an anastomosis.
Up to five arteries meet at this spot, as branches of the ophthalmic, maxillary and facial arteries; some accounts do not count the posterior ethmoidal artery (which supplies the upper nose). The lining here is thin and the vessels lie just beneath it, so dry air, nose picking, nose blowing or a minor knock can easily damage one. Minor trauma is the most common cause of epistaxis. Because the site is at the front of the nose, it can be reached with first aid: sit leaning forward and pinch the soft part of the nose firmly.
Bleeding from the back of the nose is called a posterior bleed. Posterior bleeds usually arise from the sphenopalatine artery, which runs far back in the nose. These bleeds are less common and harder to treat, and they are more likely in people with atherosclerosis (narrowed, hardened arteries), bleeding disorders or previous nasal surgery. A bleed that is profuse (very heavy), comes from both sides of the nose and has no visible source suggests a posterior origin, and it needs hospital assessment.
Key facts
- Site
- Kiesselbach's plexus (Little's area) lies on the anterior part of the nasal septum and is where most nosebleeds begin.
- Feeding arteries
- Up to five meet here. The anterior and posterior ethmoidal arteries arise from the ophthalmic artery and supply the upper nose, though some accounts do not count the posterior one. The sphenopalatine and greater palatine arteries arise from the maxillary artery, and a branch of the greater palatine runs up from the roof of the mouth to join the network. The superior labial artery arises from the facial artery.
- Why it bleeds
- The lining is thin and the vessels lie just beneath it, so dry air, picking or a knock can damage one.
- Posterior bleeds
- These usually arise from the sphenopalatine artery and are less common and harder to treat.
- Profuse bleed
- A bleed that is profuse (very heavy) and comes from both sides of the nose, with no visible source, suggests a posterior origin.
- First aid
- Sit leaning forward and pinch the soft part of the nose firmly.
Exam traps
- Bleeding from the sphenopalatine artery territory, at the back of the nose, is not the commonest site of nosebleeds, because posterior bleeds are less common and more difficult to treat than the common anterior bleed.
- Woodruff’s plexus is not the network that bleeds from the front of the septum, because it lies on the lateral nasal wall and is linked with posterior bleeding.
- The cavernous sinus (a venous channel inside the skull) is not a source of nosebleeds, because its link with the veins of the nose matters for the spread of infection into the head.
Read the full notes
Tested in 10 SimpleMed+ questions
Practice it in Head and Neck, with the answer and a full explanation after every question.
Practice these questions