Which of the following is the most common site of epistaxis in adults?

Explanation

## Anatomical Sites of Epistaxis **Key Point:** Little's area (also called Kiesselbach's triangle) is the most common site of epistaxis in both children and adults, accounting for 90% of anterior bleeds. ### Little's Area (Kiesselbach's Triangle) Little's area is a highly vascular zone located at the **anteroinferior part of the nasal septum**, formed by the convergence of five arteries: 1. Anterior ethmoidal artery (superiorly) 2. Sphenopalatine artery (posteriorly) 3. Greater palatine artery (inferiorly) 4. Septal branch of superior labial artery (anteroinferiorly) 5. Septal branch of anterior ethmoidal artery **Clinical Pearl:** This area is exposed to direct trauma, dry air, and temperature changes, making it vulnerable to bleeding. Most epistaxis in this region is self-limiting and can be managed with simple measures like pressure and topical hemostasis. ### Other Sites of Epistaxis | Site | Artery Involved | Frequency | Characteristics | |------|-----------------|-----------|------------------| | Little's area (anteroinferior septum) | Multiple (see above) | 90% of anterior bleeds | Easy to visualize, self-limiting | | Woodruff's plexus (posterior nasal cavity) | Sphenopalatine artery | Posterior bleeds | Severe, difficult to control, may need posterior packing | | Lateral nasal wall | Posterior lateral nasal arteries | Less common | Often associated with trauma | | Superior nasal cavity | Anterior ethmoidal artery | Rare | High location, difficult access | **High-Yield:** Anterior epistaxis (Little's area) is more common than posterior epistaxis in the ratio of approximately 9:1. Anterior bleeds are usually venous or from small arteries and respond well to conservative management, while posterior bleeds involve larger vessels and require aggressive intervention. **Mnemonic — KIESSELBACH:** **K**iesselbach's triangle = **I**nferanterior septum, **E**thmoidal artery (anterior), **S**phenopalatine artery, **S**uperior labial artery, **E**thmoidal artery (anterior again), **L**ateral nasal wall vessels, **B**ack of nose (posterior), **A**rtery convergence zone, **C**ommon site, **H**ighly vascular.