Despite its small size, the nose contains a rich blood supply. This makes it a common site for recurrent minor trauma, including bleeding.
The anterior septum houses an area of large blood vessels called Kiesselbach’s plexus (also known as Little’s area). About 90% of all nosebleeds originate here.
Anatomy
The Kiesselbach’s Plexus is a vascular network that supplies blood to the nasal septum. This plexus consists of five arteries:
- The anterior and posterior ethmoidal arteries
- The sphenopalatine artery
- The greater palatine artery
- The septal branch of the superior labial artery
The plexus runs vertically downwards just behind the columella and crosses the nose floor to join the venous plexus on the lateral nasal wall. It is named after Wilhelm Kiesselbach, a German otolaryngologist.
The Kiesselbach’s Plexus receives arterial blood supply from the external carotid artery (supplying the sphenopalatine, superior labial, and greater palatine arteries) and the internal carotid artery (supplying the anterior and posterior ethmoidal and ophthalmic arteries). It drains via the facial vein, ophthalmic veins, and pterygoid plexus.
Significance
The Kiesselbach plexus is located in the nasal cavity, specifically in the inferior anterior quadrant of the nasal septum, where several arteries anastomose form a vascular network or plexus. Its main function is to adjust the temperature of air inhaled through the nose via heat exchange between the arteries and the air.
The arteries of the Kiesselbach plexus are:
- The anterior and posterior ethmoidal arteries (branches of the ophthalmic artery).
- The sphenopalatine artery.
- The greater palatine artery.
- The septal branch of the superior labial artery.
The arteries of the Kiesselbach plexus receive arterial blood supply from the internal carotid artery (supplying the anterior and posterior ethmoidal and the sphenopalatine arteries) and the external carotid artery (supplying the greater palatine artery). A small venous plexus, Woodruff’s plexus, is also found in this area.
Diagnosis
The Kiesselbach’s plexus is an integral anastomosis of 5 blood vessels in the inferior anterior quadrant of the nasal septum over the septal cartilage. This area is commonly called Little’s area, Kiesselbach’s plexus, or simply “Kiesselbach’s triangle.”
The plexus supplies oxygenated blood to the nasal cavity and the adjacent airway. This vascular network is important for adjusting the air temperature as it enters the nose and body using heat exchange.
It receives arterial supply from the external carotid arteries (supplying the sphenopalatine, superior labial, and greater palatine arteries) and the internal carotid arteries (supplying the anterior and posterior ethmoidal arteries). The facial vein, ophthalmic veins, and pterygoid plexus drain the plexus.
Ninety percent of anterior nosebleeds occur in this plexus and can be diagnosed by a physician using a nasal speculum. These bleeds are commonly due to trauma, such as from a fingernail or a foreign body within the nose.
Treatment
The Kiesselbach plexus is an integral anastomosis of five arteries in the inferior anterior quadrant of the nasal septum over the septal cartilage. It is commonly referred to as Little’s area or Kiesselbach’s triangle, a common site of nosebleeds (epistaxis).
The sphenopalatine artery originates from the maxillary artery behind the jawbone and gives off the superior labial artery, which enters the nasal cavity through the nares and joins the anastomoses in Little’s area. The anterior ethmoidal artery gives off from the ophthalmic artery and joins the anastomoses in Kiesselbach’s area.
The sphenopalatine, anterior ethmoidal, and greater palatine arteries receive arterial blood from the external carotid artery; the superior labial artery receives a supply from the facial artery. The posterior ethmoidal artery also receives a supply from the internal carotid artery. This rich vascular supply is essential for the functioning of the nose, including gas exchange.
