Basic Science and Pathophysiology

An appreciation of the vascular anatomy of the nose is crucial to an understanding of the pathophysiology of epistaxis.

The anterior nasal septum is the location of number of arterial anastamoses between vessels arising from branches of the internal and external carotid arteries. This series of anastamoses are formed into a triangular shape, [10] and known as Kiesselbach’s plexus. The area of the nasal septum involved is commonly referred to as Little’s area. This is marked with the red triangle in the image opposite.

The large number of vessels concentrated in this area play an important physiological role in thermal regulation, humidification of inhaled air and control of the lumen of the nasal passages.

Bleeding not arising from Kiesselbach’s plexus, referred to as posterior epistaxis, may originate from any part of the remainder of the nasal cavity or nasopharynx.