U01.16.025 Epistaxis (Nosebleed)

Epistaxis, commonly known as a nosebleed, is a frequent condition that usually occurs in the anterior segment of the nostril. While most cases are benign and manageable, life-threatening hemorrhages can occur in the posterior segment. Understanding the vascular anatomy of the nose and common causes of epistaxis is crucial for effective management.

Anatomy of Nasal Blood Supply

Kiesselbach Plexus (Little’s Area)

The most common site of anterior nosebleeds.
It is located in the anterior segment of the nostril.
Blood supply is derived from the following arteries:
- Superior Labial Artery
- Anterior and Posterior Ethmoidal Arteries
- Greater Palatine Artery
- Sphenopalatine Artery

Posterior Segment Hemorrhage

Life-threatening and less common than anterior nosebleeds.
Involves the sphenopalatine artery, a branch of the maxillary artery.

Common Causes of Epistaxis

Foreign Body
- Objects lodged in the nasal cavity can damage blood vessels.
Trauma
- Direct injury to the nose, such as from a blow or fall, can rupture blood vessels.
Allergic Rhinitis
- Chronic inflammation and irritation of the nasal mucosa due to allergies can lead to bleeding.
Nasal Angiofibromas
- Benign tumors are common in adolescent males; they are highly vascular and can cause significant bleeding.

Table: Kiesselbach Plexus Components

Artery	Source
Superior Labial Artery	Branch of the facial artery
Anterior Ethmoidal Artery	Branch of the ophthalmic artery
Posterior Ethmoidal Artery	Branch of the ophthalmic artery
Greater Palatine Artery	Branch of the maxillary artery
Sphenopalatine Artery	Branch of the maxillary artery

Table: Kiesselbach Plexus Components

Points to Remember

The majority of nosebleeds are anterior and involve the Kiesselbach plexus.
Posterior nosebleeds, involving the sphenopalatine artery, can be life-threatening and require immediate medical attention.
Adolescents with recurrent nosebleeds, particularly males, should be evaluated for nasal angiofibroma.
“Kiesselbach drives his Lexus with his LEGS” is a helpful mnemonic to remember the arteries involved: Labial artery, Ethmoidal arteries, Greater palatine artery, and Sphenopalatine artery.

Bibliography

Schlosser, R.J., & Smith, T.L. (2009). Epistaxis: Causes, Diagnosis, and Management. Otolaryngologic Clinics of North America, 42(4), 567-575. Link.
James, A., & Panuganti, B.A. (2023). Nosebleed (Epistaxis). In StatPearls. StatPearls Publishing. Link.

Your voice matters – comment below!Cancel reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

USMLE Step 1 Review Series

Curriculum